Individual
MR. GARY H WHEELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 LEGACY PLAZA WEST, LAPORTE, IN 46350-5254
(219) 326-0943
(219) 326-5684
Mailing address
PO BOX 1690, LA PORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01031308
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000697810
ANTHEM
IN
05
—
200020420
—
IN
01
—
M400043531
MEDICARE PTAN
—
Enumeration date
03/30/2006
Last updated
10/25/2011
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