Provider Demographics
NPI:1730199472
Name:WHEELER, PENNY (MD)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S 8TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2841
Mailing Address - Country:US
Mailing Address - Phone:612-333-4822
Mailing Address - Fax:612-333-3108
Practice Address - Street 1:821 MARQUETTE AVE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2909
Practice Address - Country:US
Practice Address - Phone:612-333-4822
Practice Address - Fax:612-333-3108
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA93952Medicare UPIN