Provider Demographics
NPI:1972562718
Name:WOLFF, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:WOLFF
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 1:7 BLANCHARD CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2039
Mailing Address - Country:US
Mailing Address - Phone:630-653-2300
Mailing Address - Fax:630-653-2895
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2039
Practice Address - Country:US
Practice Address - Phone:630-653-2300
Practice Address - Fax:630-653-2895
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360885812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215643OtherBLUE CROSS BLUE SHIELD
ILL79035Medicare PIN
IL586690Medicare PIN
ILF81204Medicare UPIN
IL02215643OtherBLUE CROSS BLUE SHIELD