Provider Demographics
NPI:1962409623
Name:WOLKEN, STEPHEN HENRY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HENRY
Last Name:WOLKEN
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 1:540 E JEFFERSON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2477
Mailing Address - Country:US
Mailing Address - Phone:319-338-3623
Mailing Address - Fax:319-338-7289
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-338-3623
Practice Address - Fax:319-338-7289
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA180022815OtherRAILROAD MEDICARE
IA0039792Medicaid
IA42144513504OtherJOHN DEERE HEALTH
IA03979Medicare ID - Type Unspecified
IA0039792Medicaid