Provider Demographics
NPI:1568440030
Name:WHEELER, BRANDAN C (PA)
Entity Type:Individual
Prefix:
First Name:BRANDAN
Middle Name:C
Last Name:WHEELER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:8701 OLD TROY PIKE STE 240
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1053
Practice Address - Country:US
Practice Address - Phone:937-396-2880
Practice Address - Fax:937-396-2205
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075468Medicaid
OHPA19414Medicare PIN
OH0075468Medicaid
OHPA19415Medicare PIN