Healthcare Provider Details

I. General information

NPI: 1821008285
Provider Name (Legal Business Name): MICHAEL D WOLFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 PARKVIEW PLAZA DR STE 204
FORT WAYNE IN
46845-1707
US

IV. Provider business mailing address

PO BOX 8035
WICHITA KS
67208-0035
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-8380
  • Fax: 260-266-8385
Mailing address:
  • Phone: 316-689-9135
  • Fax: 316-689-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number04-31473
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-31473
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD2008-0241
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number01091260A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: