Provider Demographics
NPI:1841274404
Name:WHITTAKER, MICHELE JOANNE (DPM)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:JOANNE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:310 25TH AVE N STE 204
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2492
Practice Address - Country:US
Practice Address - Phone:615-327-2200
Practice Address - Fax:615-327-2842
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000550213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352970Medicaid
TN3352970Medicare PIN
TNU67414Medicare UPIN