Provider Demographics
NPI:1891803086
Name:WHEELER, ADAM D (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:WHEELER
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 1:200 CORPORATE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7172
Mailing Address - Country:US
Mailing Address - Phone:573-814-1170
Mailing Address - Fax:573-530-1037
Practice Address - Street 1:200 CORPORATE LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7172
Practice Address - Country:US
Practice Address - Phone:573-814-1170
Practice Address - Fax:573-530-1037
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009003448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360070Medicare PIN