Healthcare Provider Details

I. General information

NPI: 1265412357
Provider Name (Legal Business Name): CHAMINIE WHEELER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15530 KUTZTOWN RD STE 1
KUTZTOWN PA
19530-9758
US

IV. Provider business mailing address

15530 KUTZTOWN RD
KUTZTOWN PA
19530-9703
US

V. Phone/Fax

Practice location:
  • Phone: 484-646-3900
  • Fax: 484-646-3901
Mailing address:
  • Phone: 484-646-3900
  • Fax: 484-646-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS014483
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3610
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3610
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: