Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 5315028187 | MI |
NPI | 1184749517 |
---|---|
Provider Name | Dr. Michael Wesley Whitworth |
First Address | Wyandotte, MI 48192-6103 |
Second Address | Wyandotte, MI 48192-6103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/01/2014 |