Healthcare Provider Details

I. General information

NPI: 1841274404
Provider Name (Legal Business Name): MICHELE JOANNE WHITTAKER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 25TH AVE N STE 204
NASHVILLE TN
37203-2492
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-2200
  • Fax: 615-327-2842
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM000550
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: