Healthcare Provider Details

I. General information

NPI: 1275951469
Provider Name (Legal Business Name): MICHAEL S WHEELER BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 SEMINOLE BLVD
SEMINOLE FL
33772
US

IV. Provider business mailing address

7501 SEMINOLE BLVD
SEMINOLE FL
33772
US

V. Phone/Fax

Practice location:
  • Phone: 727-399-8040
  • Fax: 727-214-9315
Mailing address:
  • Phone: 727-399-8040
  • Fax: 727-214-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS1838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: