MEDICARE: MILES WARREN WHITAKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	36452	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538195243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILES WARREN WHITAKER MD

Provider Business Mailing Address
First Line	:	1816 DOCTORS DR
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5057
Country	:	US
Telephone Number	:	919-774-8631
Fax Number	:	919-718-0784

Provider Business Practice Location Address
First Line	:	1816 DOCTORS DR
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5057
Country	:	US
Telephone Number	:	910-484-2284
Fax Number	:	910-484-1673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	10/28/2014

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