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NPI Code Detail

MEDICARE: SUSAN WHITELY MD

MEDICARE: SUSAN WHITELY MD
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
1207Q00000XFamily Medicine Physician25229AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z61593OTHERAZMEDICARE ID

General Provider Information

NPI Number : 1427013762
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN WHITELY MD
Provider Business Mailing Address
First Line : 1835 W MISSOURI AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-3046
Country : US
Telephone Number : 602-230-0777
Fax Number :
Provider Business Practice Location Address
First Line : 1835 W MISSOURI AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-3046
Country : US
Telephone Number : 602-230-0777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 05/17/2021

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