Basic Information
| Provider Information | |||||||||
| NPI: | 1275580862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOELFFER | ||||||||
| FirstName: | KIRK | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98209 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276248209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198509111 | ||||||||
| FaxNumber: | 9198502499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1418 E MILLBROOK RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276094812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198509111 | ||||||||
| FaxNumber: | 9198502499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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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 | 213ES0103X | 426 | NC | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 890802J | 05 | NC | MEDICAID |