Provider Demographics
NPI:1366415556
Name:WOLFE, MICHAEL WAYNE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
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 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-703-7114
Mailing Address - Fax:504-842-6784
Practice Address - Street 1:1514 JEFFERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-703-7114
Practice Address - Fax:504-842-6784
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101224713207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366415556OtherAETNA
VA1366415556OtherANTHEM
VA1366415556OtherHEALTHKEEPERS PLUS
VA371194700OtherBLACK LUNG
VA1366415556OtherVIRGINIA HEALTH NETWORK
VA1366415556OtherHUMANA MEDICARE
VA1366415556Medicaid
VA540506332004OtherTRICARE/CHAMPUS
VA1366415556OtherHEALTHKEEPERS
VA1366415556OtherMEDICAID OF WEST VIRGINIA
VA1366415556OtherCIGNA
VA1366415556OtherGATEWAY
VAP00264565OtherRAILROAD MEDICARE
VA1366415556OtherUNITED HEALTHCARE
VA1366415556OtherOPTIMA HEALTH PLAN
VA1366415556OtherUMWA
VA1366415556OtherINTOTAL
VA1366415556OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1366415556OtherVA PREMIER
VA1366415556OtherMEDICAID OF WEST VIRGINIA
VA1366415556Medicaid
VA1366415556Medicaid