Provider Demographics
NPI:1013914456
Name:WOLFSTEIN, JUDITH (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:WOLFSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S GARNETT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5238
Mailing Address - Country:US
Mailing Address - Phone:918-728-6194
Mailing Address - Fax:855-917-2040
Practice Address - Street 1:744 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9020
Practice Address - Country:US
Practice Address - Phone:918-728-6194
Practice Address - Fax:918-664-2521
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062019L174400000X
MN766072085R0202X
OK262712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200198340AMedicaid
PA001745865Medicaid
OKOK400762Medicare PIN
PA024795Medicare ID - Type Unspecified
PA001745865Medicaid
PAG88159Medicare UPIN