Provider Demographics
NPI:1083779904
Name:WOLFE, WILLIAM HAROLD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HAROLD
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S. SCATTERFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013
Mailing Address - Country:US
Mailing Address - Phone:765-642-2602
Mailing Address - Fax:765-642-2608
Practice Address - Street 1:2015 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4337
Practice Address - Country:US
Practice Address - Phone:765-646-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010464492083P0500X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCK6957OtherRAILROAD GROUP
IN01046449BOtherCSR
INP00422317OtherRAILROAD INDIVIDUAL
INP00422317OtherRAILROAD INDIVIDUAL
IAGO1164Medicare UPIN