Provider Demographics
NPI:1215969928
Name:WILLHITE, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:WILLHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-689-5101
Mailing Address - Fax:812-689-6199
Practice Address - Street 1:1025 BARACHEL LN
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1269
Practice Address - Country:US
Practice Address - Phone:812-222-0051
Practice Address - Fax:812-222-0055
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4639820OtherAETNA
700254OtherFEDERAL BLACK LUNG
080117644OtherMEDICARE RAILROAD
IN413468POtherSIHO
IN000000042202OtherANTHEM BCBS
080117644OtherMEDICARE RAILROAD
700254OtherFEDERAL BLACK LUNG
F57047Medicare UPIN
F57047Medicare UPIN