MEDICARE: VICTORIA WOLFINGER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085-001641	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085-001641	OTHER	IL	STATE LICENSE #

General Provider Information

NPI Number	:	1043304694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA WOLFINGER PA-C

Provider Business Mailing Address
First Line	:	5961 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3758
Country	:	US
Telephone Number	:	312-702-3923
Fax Number	:

Provider Business Practice Location Address
First Line	:	5961 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3758
Country	:	US
Telephone Number	:	312-702-3923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/14/2020

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