Provider Demographics
NPI:1639795669
Name:WHEELOCK, COREY (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:WHEELOCK
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 1:1 HOSPITAL DR # DC043.00
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-884-1606
Mailing Address - Fax:573-884-4533
Practice Address - Street 1:1401 S CALIFORNIA AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1694
Practice Address - Country:US
Practice Address - Phone:773-565-3008
Practice Address - Fax:773-522-5855
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020017706207R00000X
IL125078145208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine