MEDICARE: DR. KEVIN JAY WOLF DPM

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	213E00000X	Podiatrist	357	NC
2	213EP1101X	Primary Podiatric Medicine Podiatrist	357	NC
3	213ES0103X	Foot & Ankle Surgery Podiatrist	357	NC
4	213ES0131X	Foot Surgery Podiatrist	357	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0818H	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1487712824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JAY WOLF DPM

Provider Business Mailing Address
First Line	:	407 N. HERMAN ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530
Country	:	US
Telephone Number	:	919-583-9788
Fax Number	:	919-583-9790

Provider Business Practice Location Address
First Line	:	407 N. HERMAN ST
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530
Country	:	US
Telephone Number	:	919-583-9788
Fax Number	:	919-583-9790

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	03/12/2014

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