MEDICARE: DR. KIMBERLY WHEELER 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	207Q00000X	Family Medicine Physician	M2198	TX

General Provider Information

NPI Number	:	1679527147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY WHEELER M.D.

Provider Business Mailing Address
First Line	:	1009 W SAN ANTONIO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-2421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 W SAN ANTONIO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-2421
Country	:	US
Telephone Number	:	512-376-5247
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/16/2007

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