Provider Demographics
NPI:1275576076
Name:WHEATLEY, MELINDA JOAN (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:JOAN
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 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
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N21610OtherMEDICARE PIN
MI0802572652OtherBLUE CROSS
MIF98019Medicare UPIN