MEDICARE: ANDREW WOLF MD

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	207W00000X	Ophthalmology Physician	4301085349	MI

General Provider Information

NPI Number	:	1376551051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WOLF MD

Provider Business Mailing Address
First Line	:	1351 WASHINGTON BLVD
Second Line	:	SUITE 101
City	:	STAMFORD
State	:	CT
Zip	:	06902-2419
Country	:	US
Telephone Number	:	203-327-5808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 WASHINGTON BLVD
Second Line	:	SUITE 101
City	:	STAMFORD
State	:	CT
Zip	:	06902-2419
Country	:	US
Telephone Number	:	203-327-5808
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	12/10/2010

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