Provider Demographics
NPI:1144428327
Name:MELINDA J WHEATLEY MD PC
Entity Type:Organization
Organization Name:MELINDA J WHEATLEY MD PC
Other - Org Name:THE PHYSICIANS CENTER FOR WELLBEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-3180
Mailing Address - Street 1:1140 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3437
Mailing Address - Country:US
Mailing Address - Phone:810-732-3180
Mailing Address - Fax:810-732-3919
Practice Address - Street 1:1140 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3437
Practice Address - Country:US
Practice Address - Phone:810-732-3180
Practice Address - Fax:810-732-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N21610Medicare PIN
MIF98019Medicare UPIN