Michelle Lynn Wolfe
Individual provider Active NPI Specialist · Tremont, IL
NPI 1629527627 · NPPES record last updated Oct 2, 2016
Key facts
- NPI
- 1629527627
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 2271999 (IL)
- Practice address
- 2668 Ashley CT
Tremont, IL 61568-9772 - Phone
- (309) 712-6056
- NPI assigned
- Oct 2, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2271999 | IL | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 2271999 | IL | Yes |
Addresses
Primary practice location
2668 Ashley CT
Tremont, IL 61568-9772
Mailing address
2668 Ashley CT
Tremont, IL 61568-9772
Phone (309) 712-6056
Other providers in Tremont, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.