Healthcare Provider Details

I. General information

NPI: 1215969928
Provider Name (Legal Business Name): MICHAEL S WILLHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BARACHEL LN
GREENSBURG IN
47240-1269
US

IV. Provider business mailing address

PO BOX 189
MADISON IN
47250-0189
US

V. Phone/Fax

Practice location:
  • Phone: 812-222-0051
  • Fax: 812-222-0055
Mailing address:
  • Phone: 812-689-5101
  • Fax: 812-689-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01042916
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: