Healthcare Provider Details

I. General information

NPI: 1831584705
Provider Name (Legal Business Name): BENJAMIN WHEELER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7973 W DESTINY BLVD
FORT CAMPBELL KY
42223-5429
US

IV. Provider business mailing address

2450 E BARD RD
MUSKEGON MI
49445-9542
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101028332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: