Healthcare Provider Details

I. General information

NPI: 1962139485
Provider Name (Legal Business Name): KAREN WHITEFOOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E BIG BEAVER RD
TROY MI
48083-1905
US

IV. Provider business mailing address

8141 ROSE LN
GOODRICH MI
48438-9210
US

V. Phone/Fax

Practice location:
  • Phone: 248-535-0936
  • Fax:
Mailing address:
  • Phone: 248-535-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704210657
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: