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General NPI Number Information
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NPI Number | 1740609270
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Entity Type | Individual
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Provider Name | DR. ANDREW WOLF
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Gender | Male
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Dates
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Enumeration Date | 04/13/2014
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Last Update Date | 04/13/2014
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY SUITE 761 JONES BUILDING RUSH UNIVERSITY MEDICAL CENTER
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-942-6095
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 N LAKEVIEW AVE APPT 3305
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City | CHICAGO
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State | IL
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Zip | 60614-1840
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Country | US
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Telephone | 312-241-4435
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Fax |
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 113000065
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License Number State | IL
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