Individual
MITCHELL A WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3214 KETHLEY RD, SHAWNEE, OK 74804-9625
(405) 273-5801
(405) 878-3794
Mailing address
PO BOX 258884, OKLAHOMA CITY, OK 73125-8884
(405) 231-3857
(405) 272-7977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
10580
NV
207Q00000X
Family Medicine Physician
Primary
18589
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506264
—
NV
01
—
P00366183
RAILROAD MEDICARE
NV
Enumeration date
10/26/2006
Last updated
11/11/2016
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