Healthcare Provider Details

I. General information

NPI: 1932734142
Provider Name (Legal Business Name): COLTEN WOLF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 HIGHLAND AVE
DOWNERS GROVE IL
60515-1500
US

IV. Provider business mailing address

3815 HIGHLAND AVE
DOWNERS GROVE IL
60515-1500
US

V. Phone/Fax

Practice location:
  • Phone: 888-584-7888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036.179517
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: