=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528232998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOROTA ANNA WHITMER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2008
-----------------------------------------------------
Last Update Date | 01/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14601 DETROIT AVE #540
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-529-5300
-----------------------------------------------------
Fax | 216-529-5301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14601 DETROIT AVE #540
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-529-5300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | D0072285
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 124545
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------