Provider Demographics
NPI:1356307730
Name:WHEATLEY, ERIC ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANDREW
Last Name:WHEATLEY
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 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:4350 JACKSON RD
Practice Address - Street 2:STE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1889
Practice Address - Country:US
Practice Address - Phone:734-971-9344
Practice Address - Fax:734-971-2303
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070291208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4701318Medicaid
700H161150OtherBLUE SHIELD
MI4701318Medicaid