Healthcare Provider Details

I. General information

NPI: 1134199615
Provider Name (Legal Business Name): TODD J WHITE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/27/2023
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W CENTRE AVE BRONSON INTERNAL MEDICINE ASSOCIATES
PORTAGE MI
49024-4828
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-324-4141
  • Fax: 269-324-2020
Mailing address:
  • Phone: 269-324-4141
  • Fax: 269-324-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101010275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: