Provider Demographics
NPI:1366609653
Name:WHEELER, SHANE C (MD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:C
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 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-363012085R0202X
HIMD174942085R0202X
NE251072085R0202X
CO466162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1366609653Medicaid
UT1679513196Medicaid
NV1366609653Medicaid
KY7100096790Medicaid
WY1366609653Medicaid
CA1366609653Medicaid
KS200602140AMedicaid
NM95452761Medicaid
IA1366609653Medicaid
UT1366609653Medicaid
SD1366609653Medicaid
OK200424590AMedicaid
NE84059792913Medicaid
NE10025709000Medicaid
CO53577710Medicaid
AZ621053Medicaid
TX204734201Medicaid
CO53577710Medicaid
TX204734201Medicaid
NE10025709000Medicaid
NEP00796279Medicare PIN
COP00643723Medicare PIN
UT1366609653Medicaid
CA1366609653Medicaid
MT1366609653Medicaid
SD1366609653Medicaid
NENA2517054Medicare PIN
COCO301087Medicare PIN
NENA1215041Medicare PIN