Provider Demographics
NPI:1114508223
Name:BERENTER, WHITNEY (DO)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:BERENTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:FRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:45441 HEYDENREICH RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6601
Mailing Address - Country:US
Mailing Address - Phone:586-226-8600
Mailing Address - Fax:
Practice Address - Street 1:45441 HEYDENREICH RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-6601
Practice Address - Country:US
Practice Address - Phone:586-226-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014583390200000X
MI390200000X
MI5101027524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program