Organization
WOLFE MOBILE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS ANDREW WOLFE MD (MEMBER)
(920) 253-5851
Entity
Organization
Contact information
Practice address
510 GREY FOX RUN, WATERTOWN, WI 53094-5901
(920) 253-5851
Mailing address
510 GREY FOX RUN, WATERTOWN, WI 53094-5901
(920) 253-5851
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
29319-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003998394
NPI ENUMERATOR
—
01
—
29319
WI, DEPT REGULATION & LIS
WI
05
—
31425500
—
WI
Enumeration date
11/02/2007
Last updated
11/02/2007
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