MEDICARE: DR. BRADLEY R WOLF M.D.

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	174400000X	Specialist	35.052721	OH

General Provider Information

NPI Number	:	1356616817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY R WOLF M.D.

Provider Business Mailing Address
First Line	:	11877 MASON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-4714
Country	:	US
Telephone Number	:	513-774-0400
Fax Number	:	513-774-0410

Provider Business Practice Location Address
First Line	:	11877 MASON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-4714
Country	:	US
Telephone Number	:	513-774-0400
Fax Number	:	513-774-0410

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

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	03/16/2012

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