Healthcare Provider Details

I. General information

NPI: 1831150200
Provider Name (Legal Business Name): IRA S. WOLKE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 GLENAYRE DR
GLENVIEW IL
60025-3106
US

IV. Provider business mailing address

930 GLENAYRE DR
GLENVIEW IL
60025-3106
US

V. Phone/Fax

Practice location:
  • Phone: 312-441-1313
  • Fax:
Mailing address:
  • Phone: 312-441-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number036.100183
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number036.100183
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD432831
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number41397
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD432831
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.100183
License Number StateIN
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-100183
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD432831
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: