Healthcare Provider Details

I. General information

NPI: 1245285055
Provider Name (Legal Business Name): HIRAM JEFFERY WHITAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 INNOVATION PKWY #100
GREENWOOD IN
46143-3601
US

IV. Provider business mailing address

8450 NORTHWEST BLVD
INDIANAPOLIS IN
46278-1381
US

V. Phone/Fax

Practice location:
  • Phone: 317-884-5200
  • Fax: 317-884-5360
Mailing address:
  • Phone: 317-802-2000
  • Fax: 317-802-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01037479A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number01037479
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: