Healthcare Provider Details

I. General information

NPI: 1124281167
Provider Name (Legal Business Name): TYRUS MICHAEL WHITE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY BAPTIST HEALTH CANCER CENTER
CORBIN KY
40701-8727
US

IV. Provider business mailing address

5200 COMMERCE CROSSINGS DR FL FLOOR
LOUISVILLE KY
40229-2182
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-1934
  • Fax: 606-523-1982
Mailing address:
  • Phone: 502-253-4924
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number42601
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: