MEDICARE: LARRY WHEELER C.PED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224L00000X	Pedorthist	111233	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	5939230001	OTHER	KY	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000519294	OTHER	KY	ANTHEM BC/BS
2	208278527	OTHER	KY	HUMANA
3	5574649	OTHER	KY	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	208278527	OTHER	KY	TRICARE

General Provider Information

NPI Number	:	1104939156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY WHEELER C.PED

Provider Business Mailing Address
First Line	:	371 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1824
Country	:	US
Telephone Number	:	859-266-0420
Fax Number	:	859-266-0667

Provider Business Practice Location Address
First Line	:	371 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1824
Country	:	US
Telephone Number	:	859-266-0420
Fax Number	:	859-266-0667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	11/21/2016

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Directions to “ LARRY WHEELER C.PED” Practice Location

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