Healthcare Provider Details

I. General information

NPI: 1841257417
Provider Name (Legal Business Name): JEFFREY MICHAEL WHITAKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 MARKET AVE S
CANTON OH
44702-2165
US

IV. Provider business mailing address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-4600
  • Fax:
Mailing address:
  • Phone: 216-791-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003676
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: