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General NPI Number Information
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NPI Number | 1710541206
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Entity Type | Individual
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Provider Name | BRANDON ALEXANDER WHEATLEY MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVENUE ROOM A700 - MC 7082
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City | CHICAGO
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State | IL
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Zip | 60637
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Country | US
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Telephone | 773-702-1447
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR STE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-4503
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Country | US
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Telephone | 773-702-1150
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 62051
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License Number State | TN
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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 | 62051
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.083226
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License Number State | IL
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