MEDICARE: DR. PENNIANN WHITTEN 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
1	207Q00000X	Family Medicine Physician	33671	AZ

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	:	1871563197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNIANN WHITTEN MD

Provider Business Mailing Address
First Line	:	4635 N 22ND ST
Second Line	:	UNIT 118
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4643
Country	:	US
Telephone Number	:	480-783-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13838 S 46TH PL
Second Line	:	STE 125
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7800
Country	:	US
Telephone Number	:	480-783-7000
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/27/2021

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Directions to “ DR. PENNIANN WHITTEN MD” Practice Location

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