Healthcare Provider Details

I. General information

NPI: 1801435276
Provider Name (Legal Business Name): RICHARD M WOLKOWITZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N KEENE ST STE 107
COLUMBIA MO
65201-6897
US

IV. Provider business mailing address

8000 S TURTLE CREEK LN
COLUMBIA MO
65203-9334
US

V. Phone/Fax

Practice location:
  • Phone: 573-239-3310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD WOLKOWITZ
Title or Position: MD
Credential:
Phone: 573-239-3310