Provider Demographics
NPI:1770874737
Name:S. ANTHONY WOLFE, M.D., P.A.
Entity type:Organization
Organization Name:S. ANTHONY WOLFE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-662-4111
Mailing Address - Street 1:PO BOX 558267
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-8267
Mailing Address - Country:US
Mailing Address - Phone:305-662-4111
Mailing Address - Fax:305-662-5800
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:SUITE 2230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-4111
Practice Address - Fax:305-662-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055617300Medicaid
FL103876OtherAVMED
FL4608053OtherAETNA
FL0151094-001OtherCIGNA HEALTH PLANS
FL210923OtherAMERIGROUP
FL210923OtherAMERIGROUP
FL103876OtherAVMED