Healthcare Provider Details

I. General information

NPI: 1760421861
Provider Name (Legal Business Name): LARRY CURTIS WHITE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 N MAIN ST
ROMEO MI
48065-4619
US

IV. Provider business mailing address

2250 E GUNN RD
ROCHESTER MI
48306-1931
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-9694
  • Fax: 586-752-7871
Mailing address:
  • Phone: 248-652-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLW006210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: