NPIMap

Organization Active NPI

Wheaton Internal Medicine, LTD.

  • Internal Medicine Physician
  • Carol Stream, IL
National Provider Identifier
1124010202
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WHEATON INTERNAL MEDICINE, LTD.
Practice address
327 Gundersen Dr
Suite a
Carol Stream, IL 60188-2402
Phone
(630) 681-0640
Fax
(630) 681-0659
NPI assigned
Aug 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Mamie T. Martin
Title
Business Office Manager
Phone
(630) 681-0640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X IL Primary

Addresses

Primary practice location

327 Gundersen Dr
Suite a
Carol Stream, IL 60188-2402

Mailing address

327 Gundersen Dr
Suite a
Carol Stream, IL 60188-2402
Phone (630) 681-0640

Other identifiers 1

IdentifierTypeStateIssuer
M05974OtherILBCBS OF IL

National Provider Directory

National Provider Directory

Locations

430 Pennsylvania Ave
Ste 310
Glen Ellyn, IL 60137
Phone (630) 789-4910

350 S Northwest Hwy
Ste 200
Park Ridge, IL 60068

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124010202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 GUNDERSEN DR",
            "address_2": "SUITE A",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882402",
            "telephone_number": "630-681-0640",
            "fax_number": "630-681-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 GUNDERSEN DR",
            "address_2": "SUITE A",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882402",
            "telephone_number": "630-681-0640",
            "fax_number": "630-681-0659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHEATON INTERNAL MEDICINE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MAMIE",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "630-681-0640",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "M05974",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carol Stream, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.