Healthcare Provider Details

I. General information

NPI: 1205905452
Provider Name (Legal Business Name): ROBERT ANTHONY WOLFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

IV. Provider business mailing address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-1655
  • Fax: 218-634-1094
Mailing address:
  • Phone: 218-634-1655
  • Fax: 218-634-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53272-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43830
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: