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General NPI Number Information
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NPI Number | 1124021142
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Entity Type | Individual
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Provider Name | MARK H DEWOLFE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 5400 N OAK TRFY SUITE 101
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City | KANSAS CITY
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State | MO
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Zip | 64118-4688
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Country | US
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Telephone | 816-454-1658
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Fax | 816-454-1734
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Provider Business Mailing Address
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Address Line | 901 E 104TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64131-4517
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Country | US
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Telephone | 816-502-8752
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Fax | 816-932-9670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R3A25
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 04-19790
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License Number State | KS
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