MEDICARE: MARY C WHITMER D.O.

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	207Q00000X	Family Medicine Physician	5101009009	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080017993	OTHER	MI	RR MEDICARE GROUP#CC2139

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609884436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C WHITMER D.O.

Provider Business Mailing Address
First Line	:	128 MICHIGAN AVE
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-1929
Country	:	US
Telephone Number	:	906-428-4084
Fax Number	:	906-428-1881

Provider Business Practice Location Address
First Line	:	128 MICHIGAN AVE
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-1929
Country	:	US
Telephone Number	:	906-428-4084
Fax Number	:	906-428-1881

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	01/22/2009

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