Healthcare Provider Details

I. General information

NPI: 1669050480
Provider Name (Legal Business Name): MADELINE JOAN WHEATLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELINE JOAN-DONOVAN-PETER WHEATLEY MD

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE STE 5200
GRAND RAPIDS MI
49503-2572
US

IV. Provider business mailing address

25 MICHIGAN ST NE STE 5200
GRAND RAPIDS MI
49503-2572
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3681
  • Fax:
Mailing address:
  • Phone: 616-391-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301514584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: