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NPI Code Detail

MEDICARE: MADISON JANE WHITESEL

MEDICARE:   MADISON JANE WHITESEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianMI

General Provider Information

NPI Number : 1114875028
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON JANE WHITESEL
Provider Business Mailing Address
First Line : 200 S WENONA ST STE 195170
Second Line :
City : BAY CITY
State : MI
Zip : 48706-8820
Country : US
Telephone Number : 313-497-2665
Fax Number :
Provider Business Practice Location Address
First Line : 200 S WENONA ST STE 195170
Second Line :
City : BAY CITY
State : MI
Zip : 48706-8820
Country : US
Telephone Number : 313-497-2665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ MADISON JANE WHITESEL ” Practice Location

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