Provider Demographics
NPI:1083665939
Name:WHEELER, STEPHEN FRANK (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FRANK
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-562-6810
Mailing Address - Fax:502-562-6777
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-562-6503
Practice Address - Fax:502-562-6504
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64262157Medicaid
KY0048420Medicare PIN
KY1271128Medicare PIN
KY0631208Medicare PIN
KY0523912Medicare PIN
KY0766101Medicare PIN
KY64262157Medicaid