| Doctor Name: | MICHAEL K WOLVERSON |
| NPI Number: | 1972523322 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | R8237 |
| Business Practice Address: | 3635 Vista Ave Saint Louis, MO - 631102539 |
| Business Phone Number: | 3142685783 |
| Business Fax Number: | 3142685116 |
| Mailing Address: | 3691 Rutger St, Provider Enrollment SAINT LOUIS |
| State: | MO |
| Postal Code: | 631102515 |
| Phone Number: | 3149774440 |
| Fax Number: | |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 03/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | R8237 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |