Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 01041624 | IN |
Y | 207RX0202X | Medical Oncology | 01041624 | IN |
NPI | 1063404002 |
---|---|
Provider Name | Thomas L Whittaker |
First Address | Indianapolis, IN 46250-2777 |
Second Address | Greenfield, IN 46140-1357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 10/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100323710 | (05) | IN |
900000282 | RAILROAD MEDICARE PIN (01) | IN |
E59639 | (02) | |
P01055080 | RAILROAD MEDICARE PIN (01) | IN |