Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036113540 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036-113540 | IL |
NPI | 1053328831 |
---|---|
Provider Name | Ronald D. Wheeler |
First Address | Macomb, IL 61455-3313 |
Second Address | Macomb, IL 61455-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 12/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036113540 | (05) | IL |
110510 | HEALTH ALLIANCE (01) | |
A44601 | (02) |