Individual
DR. MYLES SELIG WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
251 E HURON ST, NORTHWESTERN MEMORIAL HOSPITAL - GALTER PAVILION 18-250, CHICAGO, IL 60611-2908
(312) 695-9797
Mailing address
680 N. LAKE SHORE DRIVE, SUITE 1000, NORTHWESTERN MEDICAL FACULTY FOUNDATION, INC., CHICAGO, IL 60611-4546
(312) 695-9797
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
157288
MA
207RN0300X
Nephrology Physician
Primary
036134262
IL
207RN0300X
Nephrology Physician
157288
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0172481
—
MA
01
—
157288
TUFTS HEALTH PLAN
MA
01
—
J24987
BCBS MA
MA
Enumeration date
11/04/2005
Last updated
12/12/2013
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