Healthcare Provider Details

I. General information

NPI: 1114508223
Provider Name (Legal Business Name): WHITNEY BERENTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY FRON DO

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45441 HEYDENREICH RD
MACOMB MI
48044-6601
US

IV. Provider business mailing address

45441 HEYDENREICH RD
MACOMB MI
48044-6601
US

V. Phone/Fax

Practice location:
  • Phone: 586-226-8600
  • Fax:
Mailing address:
  • Phone: 586-226-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5151014583
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101027524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: