Healthcare Provider Details

I. General information

NPI: 1598889651
Provider Name (Legal Business Name): RICHARD D WOLFF, DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 ISAAC STREETS DR SUITE 133
OREGON OH
43616-3291
US

IV. Provider business mailing address

1050 ISAAC STREETS DR SUITE 133
OREGON OH
43616-3291
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-0055
  • Fax: 419-693-5025
Mailing address:
  • Phone: 419-693-0055
  • Fax: 419-693-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.003380
License Number StateOH

VIII. Authorized Official

Name: DR. RICHARD DAVID WOLFF
Title or Position: PRESIDENT
Credential: DPM
Phone: 419-693-0055