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NPI Code Detail

MEDICARE: HEATHER J. WOLFE MD

MEDICARE: HEATHER J. WOLFE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician01056650AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760486187
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER J. WOLFE MD
Provider Business Mailing Address
First Line : 6920 POINTE INVERNESS WAY STE 200
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7934
Country : US
Telephone Number : 260-435-2852
Fax Number : 260-435-6695
Provider Business Practice Location Address
First Line : 7950 W JEFFERSON BLVD STE 210
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4140
Country : US
Telephone Number : 260-435-2852
Fax Number : 260-435-6695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/14/2021

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Directions to “ HEATHER J. WOLFE MD” Practice Location

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