Healthcare Provider Details

I. General information

NPI: 1932262847
Provider Name (Legal Business Name): ANGELA WHEELER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 KELLE DR
CHESTERTON IN
46304-8708
US

IV. Provider business mailing address

205 MILLERSPRINGS CT
FRANKLIN TN
37064-5434
US

V. Phone/Fax

Practice location:
  • Phone: 219-395-2200
  • Fax: 219-983-1837
Mailing address:
  • Phone: 888-830-4255
  • Fax: 615-468-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01044117
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: