Organization
MODERN MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE WOLFE (OWNER)
(314) 396-9517
Entity
Organization
Contact information
Practice address
5139 MATTIS RD STE 102, SAINT LOUIS, MO 63128-2250
(314) 396-9517
Mailing address
5139 MATTIS RD STE 102, SAINT LOUIS, MO 63128-2250
(314) 396-9517
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP1100X
Podiatric Clinic/Center
—
—
Other
Enumeration date
02/16/2024
Last updated
01/31/2025
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