MEDICARE: DR. PAUL W. WOLPERT 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	208600000X	Surgery Physician	3864	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CN8257	OTHER	SD	GRP RR MEDICARE
5	CP8566	OTHER	IA	GRP RR MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3864	OTHER	SD	SOUTH DAKOTA LICENSE #
6	0003667	OTHER	SD	WELLMARK SOUTH DAKOTA
7	11456	OTHER	NE	NEBRASKA LICENSE NUMBER
8	18017	OTHER	IA	IOWA LICENSE NUMBER

General Provider Information

NPI Number	:	1497758718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL W. WOLPERT M.D.

Provider Business Mailing Address
First Line	:	612 N SIOUX POINT RD
Second Line	:	STE 400
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5088
Country	:	US
Telephone Number	:	605-232-6353
Fax Number	:	605-232-6500

Provider Business Practice Location Address
First Line	:	612 N SIOUX POINT RD
Second Line	:	STE 400
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5088
Country	:	US
Telephone Number	:	605-232-6353
Fax Number	:	605-232-6500

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/18/2007

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Directions to “ DR. PAUL W. WOLPERT M.D.” Practice Location

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