Healthcare Provider Details

I. General information

NPI: 1114085693
Provider Name (Legal Business Name): TAMARA SUE WHEELER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MINNESOTA DR STE 800
EDINA MN
55435-7915
US

IV. Provider business mailing address

3600 MINNESOTA DR STE 800
EDINA MN
55435-7915
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1100
  • Fax:
Mailing address:
  • Phone: 952-595-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4752
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: