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NPI Code Detail

MEDICARE: DR. KARL KONRAD WOLF M.D.

MEDICARE: DR. KARL KONRAD 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
1207Q00000XFamily Medicine PhysicianA24460CA

General Provider Information

NPI Number : 1861470791
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KARL KONRAD WOLF M.D.
Provider Business Mailing Address
First Line : 1262 E NORTH ST
Second Line :
City : MANTECA
State : CA
Zip : 95336-4962
Country : US
Telephone Number : 209-823-7646
Fax Number : 209-824-5374
Provider Business Practice Location Address
First Line : 1262 E NORTH ST
Second Line :
City : MANTECA
State : CA
Zip : 95336-4962
Country : US
Telephone Number : 209-823-7646
Fax Number : 209-824-5374
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 11/03/2011

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