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General NPI Number Information
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NPI Number | 1659337020
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD WHITING MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 11601 MONTGOMERY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2660
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Country | US
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Telephone | 505-814-1995
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 CAMINO DE CRUZ BLANCA
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City | SANTA FE
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State | NM
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Zip | 87505-0380
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 93-424
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License Number State | NM
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