Provider Demographics
NPI:1255375218
Name:WHEELER, JEFFREY A (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
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 1:950 N MERIDIAN ST
Mailing Address - Street 2:STE 500 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3908
Mailing Address - Country:US
Mailing Address - Phone:317-962-4945
Mailing Address - Fax:317-962-4950
Practice Address - Street 1:13100 136TH STREET
Practice Address - Street 2:SUITE 1200
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9748
Practice Address - Country:US
Practice Address - Phone:317-678-3100
Practice Address - Fax:317-678-3108
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039503207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100464300Medicaid
INP00924304Medicare PIN
IN147070DMedicare PIN
IN110104871Medicare PIN
INF81835Medicare UPIN
IN100464300Medicaid