Healthcare Provider Details

I. General information

NPI: 1891803086
Provider Name (Legal Business Name): ADAM D WHEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CORPORATE LAKE DR
COLUMBIA MO
65203-7172
US

IV. Provider business mailing address

200 CORPORATE LAKE DR
COLUMBIA MO
65203-7172
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-1170
  • Fax: 573-530-1037
Mailing address:
  • Phone: 573-814-1170
  • Fax: 573-530-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009003448
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: