Healthcare Provider Details

I. General information

NPI: 1255773149
Provider Name (Legal Business Name): THURMAN WHEELER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE., BOX 645
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVE., BOX 645
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-6177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number235238-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: