Healthcare Provider Details

I. General information

NPI: 1780665836
Provider Name (Legal Business Name): CRAIG A WHEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 MILLENNIUM SUITE 100
LANSING MI
48917-7831
US

IV. Provider business mailing address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 517-367-5220
  • Fax: 517-367-5245
Mailing address:
  • Phone: 810-342-1000
  • Fax: 810-342-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301038070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: