Healthcare Provider Details

I. General information

NPI: 1073501714
Provider Name (Legal Business Name): MICHAEL J WHITTERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 13TH AVE SW
CLARION IA
50525-2078
US

IV. Provider business mailing address

PO BOX 271 215 13TH AVE SW
CLARION IA
50525-0271
US

V. Phone/Fax

Practice location:
  • Phone: 515-532-2836
  • Fax: 515-532-2523
Mailing address:
  • Phone: 515-532-2836
  • Fax: 515-532-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAW1611563
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: