Healthcare Provider Details

I. General information

NPI: 1659337020
Provider Name (Legal Business Name): MICHAEL EDWARD WHITING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2660
US

IV. Provider business mailing address

1224 CAMINO DE CRUZ BLANCA
SANTA FE NM
87505-0380
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number93-424
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: