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General NPI Number Information
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NPI Number | 1518379650
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Entity Type | Individual
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Provider Name | MICHAEL WHITE JR.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 3100 BROADWAY ST. SUITE 400
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City | DETROIT
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State | MI
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Zip | 48226-2202
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Country | US
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Telephone | 586-335-2006
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Fax | 586-279-3886
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Provider Business Mailing Address
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Address Line | 16134 COLLINSON AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-3651
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Country | US
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Telephone | 313-585-3534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704288194
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License Number State | MI
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