Provider Demographics
NPI:1578507257
Name:WHEELER, BEVERLY G (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:G
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2248 SHAWNEE DR
Mailing Address - Street 2:APT. 2
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-5106
Mailing Address - Country:US
Mailing Address - Phone:812-801-7322
Mailing Address - Fax:813-288-8032
Practice Address - Street 1:534 E COURT AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4028
Practice Address - Country:US
Practice Address - Phone:812-288-8030
Practice Address - Fax:813-288-8032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA80477Medicare UPIN