MEDICARE: HEATHER J. WOLFE 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	208000000X	Pediatrics Physician	01056650A	IN

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

General Provider Information

NPI Number	:	1760486187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER J. WOLFE MD

Provider Business Mailing Address
First Line	:	6920 POINTE INVERNESS WAY STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7934
Country	:	US
Telephone Number	:	260-435-2852
Fax Number	:	260-435-6695

Provider Business Practice Location Address
First Line	:	7950 W JEFFERSON BLVD STE 210
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-435-2852
Fax Number	:	260-435-6695

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/14/2021

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Directions to “ HEATHER J. WOLFE MD” Practice Location

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