Provider Demographics
NPI:1609988302
Name:WHEELER, WILLIAM GLENN II (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GLENN
Last Name:WHEELER
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:365 ASHCREEK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5835
Mailing Address - Country:US
Mailing Address - Phone:270-534-1877
Mailing Address - Fax:270-477-0033
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4463
Practice Address - Fax:270-441-4461
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY19864208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1970001Medicare PIN
KYC68835Medicare UPIN