Provider Demographics
NPI:1124281167
Name:WHITE, TYRUS MICHAEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:TYRUS
Middle Name:MICHAEL
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR FL FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4924
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:BAPTIST HEALTH CANCER CENTER
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8727
Practice Address - Country:US
Practice Address - Phone:606-523-1934
Practice Address - Fax:606-523-1982
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2020-12-16
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Provider Licenses
StateLicense IDTaxonomies
KY42601207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100160280Medicaid
KYP01428671OtherRR MEDICARE
KYK002342Medicare PIN
KY0169Medicare PIN