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General NPI Number Information
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NPI Number | 1184677825
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Entity Type | Individual
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Provider Name | ELIZABETH MOBERG-WOLFF MD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 3333 N MAYFAIR RD STE 103
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City | WAUWATOSA
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State | WI
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Zip | 53222-3219
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Country | US
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Telephone | 262-527-1998
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Fax | 866-562-3609
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Provider Business Mailing Address
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Address Line | 18970 CAVENDISH RD
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City | BROOKFIELD
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State | WI
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Zip | 53045-8159
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Country | US
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Telephone | 262-527-1998
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Fax | 866-562-3609
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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 | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | 32483
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License Number State | WI
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