Individual
PROF. RANDALL KEVIN WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6550 FANNIN ST STE 1401, HOUSTON, TX 77030
(713) 441-5200
Mailing address
6550 FANNIN ST STE 1401, HOUSTON, TX 77030-2738
(713) 441-5200
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
01029011A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
35-051891
OH
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
Q3312
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0723506
—
OH
05
—
100093980
—
IN
05
—
345451403
—
TX
05
—
64862964
—
KY
01
—
P01080757
RAILROAD PTAN
IN
01
—
P01214586
RR MEDICARE PTAN
IN
Enumeration date
03/09/2006
Last updated
03/04/2019
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