MEDICARE: BRANDAN C WHEELER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50001813	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568440030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDAN C WHEELER PA

Provider Business Mailing Address
First Line	:	1 PRESTIGE PL STE 550
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-6115
Country	:	US
Telephone Number	:	937-762-1310
Fax Number	:	937-522-8068

Provider Business Practice Location Address
First Line	:	8701 OLD TROY PIKE STE 240
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1053
Country	:	US
Telephone Number	:	937-396-2880
Fax Number	:	937-396-2205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	08/11/2022

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Directions to “ BRANDAN C WHEELER PA” Practice Location

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