Individual
DR. BLAISE JOSEPH WOLFRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1375 E SCHAUMBURG RD, SUITE 260, SCHAUMBURG, IL 60194-5166
(847) 895-4540
(847) 895-4544
Mailing address
1375 E SCHAUMBURG RD, SUITE 260, SCHAUMBURG, IL 60194-5166
(847) 895-4540
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036079918
IL
2084P0802X
Addiction Psychiatry Physician
036079918
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079918
—
IL
Enumeration date
10/19/2006
Last updated
08/20/2015
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