Provider Demographics
NPI:1902808611
Name:WHEELER, WENDELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15821 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1506
Mailing Address - Country:US
Mailing Address - Phone:708-225-0200
Mailing Address - Fax:708-225-0202
Practice Address - Street 1:15821 S PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1506
Practice Address - Country:US
Practice Address - Phone:708-225-0200
Practice Address - Fax:708-225-0202
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-068196208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D88608Medicare UPIN