Basic Information
| Provider Information | |||||||||
| NPI: | 1346405511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWOLF | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 S TAMIAMI TRL | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342369116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413630878 | ||||||||
| FaxNumber: | 9414605599 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 ALLEGHENY CTR | ||||||||
| Address2: | 8TH FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152125255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123304000 | ||||||||
| FaxNumber: | 4123304366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2008 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME139695 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 161729 | 01 | PA | MEDICARE | OTHER | 002110142 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0102366252000 | 05 | PA | MEDICAID |