Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 036-105593 | IL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 036105593 | IL |
NPI | 1679668123 |
---|---|
Provider Name | Richard John Wolfe |
First Address | Mount Prospect, IL 60056-6039 |
Second Address | Mount Prospect, IL 60056-6039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 19/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-105593 | (05) | IL |
H78846 | (02) | IL |