MEDICARE: DR. WENDELL T WHEAT M.D.

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	174400000X	Specialist	MD0000009011	TN

General Provider Information

NPI Number	:	1376565382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDELL T WHEAT M.D.

Provider Business Mailing Address
First Line	:	6005 PARK AVE STE 601
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5216
Country	:	US
Telephone Number	:	901-680-9205
Fax Number	:	901-821-0078

Provider Business Practice Location Address
First Line	:	6005 PARK AVE STE 601
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5216
Country	:	US
Telephone Number	:	901-680-9205
Fax Number	:	901-821-0078

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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