Healthcare Provider Details

I. General information

NPI: 1154610491
Provider Name (Legal Business Name): BRIAN A WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W CENTRAL RD STE 8100
ARLINGTON HEIGHTS IL
60005-2391
US

IV. Provider business mailing address

880 W CENTRAL RD STE 8100
ARLINGTON HEIGHTS IL
60005-2391
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-7226
  • Fax: 847-255-0156
Mailing address:
  • Phone: 847-255-7226
  • Fax: 847-255-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036134931
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036134931
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: