Provider Demographics
NPI:1154372001
Name:WHEELER, PATRICIA W (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:W
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST LIBERTY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-426-0606
Mailing Address - Fax:502-426-0604
Practice Address - Street 1:9520 ORMSBY STATION RD. STE 175
Practice Address - Street 2:PLAZA III HURSTBOURNE GREEN
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-426-0606
Practice Address - Fax:502-426-0604
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64004443Medicaid
IN200197760Medicaid
F93844Medicare UPIN
IN200197760Medicaid