1104087840 NPI number — WILLIAM MICHAEL WOLF M.D.

Table of content: WILLIAM MICHAEL WOLF M.D. (NPI 1104087840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104087840 NPI number — WILLIAM MICHAEL WOLF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
WILLIAM
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
JANE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SECRETARY
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104087840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3999 RICHMOND RD
Provider Second Line Business Mailing Address:
HARRINGTON HEART AND VASCULAR INSTITUTE
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-6046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-593-1303
Provider Business Mailing Address Fax Number:
216-593-1301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3999 RICHMOND RD
Provider Second Line Business Practice Location Address:
HARRINGTON HEART AND VASCULAR INSTITUTE
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-6046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-593-1303
Provider Business Practice Location Address Fax Number:
216-593-1301
Provider Enumeration Date:
06/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD431601 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 35-095506 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3071956 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".