Healthcare Provider Details

I. General information

NPI: 1508813106
Provider Name (Legal Business Name): MICHAEL N WHISENANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 8TH ST GRADE
LEWISTON ID
83501-7301
US

IV. Provider business mailing address

122 W 7TH AVE 450
SPOKANE WA
99204-2349
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-1383
  • Fax: 208-298-0727
Mailing address:
  • Phone: 509-455-8820
  • Fax: 509-838-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM-9628
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: