Healthcare Provider Details

I. General information

NPI: 1619970944
Provider Name (Legal Business Name): MARK EDWARD WHEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

IV. Provider business mailing address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-2615
  • Fax: 605-217-2915
Mailing address:
  • Phone: 605-217-2615
  • Fax: 605-217-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3857
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: