Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901000896 | MI |
Y | 222Z00000X | Podiatrist | 5901000896 | MI |
N | 213ES0131X | Foot Surgery | 5901000896 | MI |
NPI | 1336217496 |
---|---|
Provider Name | Dr. Louis Eldean White |
First Address | Jackson, MI 49203-5594 |
Second Address | Jackson, MI 49203-5594 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 07/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336 | HEALTH PLAN OF MICHIGAN (01) | MI |
2102153 | (05) | MI |
2728009 | PHYSICIANS HEALTH PLAN (01) | MI |
4853851270 | BCBSM (01) | MI |
T33986 | (02) | MI |