Provider Demographics
NPI:1285621466
Name:GEORGE C WHITAKER MD PC
Entity type:Organization
Organization Name:GEORGE C WHITAKER MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-343-0377
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:STE 120
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-343-0377
Mailing Address - Fax:269-343-4744
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:STE 120
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1650
Practice Address - Country:US
Practice Address - Phone:269-343-0377
Practice Address - Fax:269-343-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C91097OtherBCBSM
5610603OtherAETNA
MI2836356Medicaid
MI2368660OtherCIGNA
MI0237160001Medicare NSC
MI2836356Medicaid
5610603OtherAETNA