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General NPI Number Information
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NPI Number | 1336290436
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Entity Type | Organization
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Legal Business Name | DENNIS MICHAEL WOLF, M.D., LTD.
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 6826 WINDSOR AVE
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City | BERWYN
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State | IL
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Zip | 60402-3441
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Country | US
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Telephone | 708-795-5566
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Fax | 708-788-0517
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Provider Business Mailing Address
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Address Line | 6826 WINDSOR AVE
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City | BERWYN
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State | IL
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Zip | 60402-3441
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Country | US
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Telephone | 708-795-5566
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Fax | 708-788-0517
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DENNIS MICHAEL WOLF
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Credential | M.D.
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Telephone | 708-795-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036064616
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License Number State | IL
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