Provider Demographics
NPI:1336554369
Name:WHEELER, LAUREN E (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:HOLMGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-782-8700
Mailing Address - Fax:270-782-8704
Practice Address - Street 1:1211 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3383
Practice Address - Country:US
Practice Address - Phone:270-782-8700
Practice Address - Fax:270-782-8704
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.065068208000000X
KY50108208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100452090Medicaid