Provider Demographics
NPI:1144261801
Name:WOLF, MITCHELL D (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:D
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1248
Mailing Address - Country:US
Mailing Address - Phone:608-282-2000
Mailing Address - Fax:608-282-2172
Practice Address - Street 1:1025 REGENT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1248
Practice Address - Country:US
Practice Address - Phone:608-282-2000
Practice Address - Fax:608-282-2172
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32248-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144261801Medicaid
WI3287OtherDEAN HEALTH INSURANCE
E52143Medicare UPIN
WI31803800Medicaid
WI028454340Medicare PIN
WI010157085Medicare PIN
WI3287OtherDEAN HEALTH INSURANCE
WI180020310Medicare PIN