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General NPI Number Information
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NPI Number | 1225423031
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Entity Type | Individual
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Provider Name | NATAKKI WHEATLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 23832 SOUTHFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-569-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 24661 COOLIDGE HWY
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City | OAK PARK
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State | MI
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Zip | 48237-1449
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Country | US
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Telephone | 248-398-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125.067639
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301116381
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License Number State | MI
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