MEDICARE: MR. WILLIE ANTHONY WHITFIELD SR.

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1205652120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIE ANTHONY WHITFIELD SR.

Provider Business Mailing Address
First Line	:	62 FAIRWAY LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1215
Country	:	US
Telephone Number	:	561-827-0304
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 FAIRWAY LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1215
Country	:	US
Telephone Number	:	561-827-0304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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