MEDICARE: DR. LISA MARIE WHEELOCK 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	2085P0229X	Pediatric Radiology Physician	25033	NE
2	2085U0001X	Diagnostic Ultrasound Physician	6115	NE

General Provider Information

NPI Number	:	1922127174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE WHEELOCK M.D.

Provider Business Mailing Address
First Line	:	19464 WALNUT CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68130-3759
Country	:	US
Telephone Number	:	402-968-6349
Fax Number	:

Provider Business Practice Location Address
First Line	:	42ND AND EMILE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-0001
Country	:	US
Telephone Number	:	402-559-1018
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/12/2026

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