Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301088448 | MI |
N | 2080P0203X | Pediatric Critical Care Doctor | 4301088448 | MI |
NPI | 1164637906 |
---|---|
Provider Name | Dr. Brent G Whittaker |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 22/02/2021 |