Healthcare Provider Details

I. General information

NPI: 1295099653
Provider Name (Legal Business Name): STEVEN RICHARD WHEALON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2012
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16216 BAXTER RD
CHESTERFIELD MO
63017-4770
US

IV. Provider business mailing address

5669 DALTON LN
SMITHTON IL
62285-2946
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-3591
  • Fax:
Mailing address:
  • Phone: 253-293-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018030704
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: