Provider Demographics
NPI:1104890318
Name:WOLF, CYRIL (MD)
Entity type:Individual
Prefix:
First Name:CYRIL
Middle Name:
Last Name:WOLF
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 1:902 FROSTWOOD
Mailing Address - Street 2:STE 290
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:281-876-3847
Mailing Address - Fax:713-467-7421
Practice Address - Street 1:902 FROSTWOOD
Practice Address - Street 2:STE 290
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:281-876-3847
Practice Address - Fax:713-467-7421
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9028207Q00000X
CAC40883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C23700Medicare UPIN
00340JMedicare ID - Type Unspecified