Provider Demographics
NPI:1407858046
Name:WHITTEN, BROOKE D (DO)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:D
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DECATUR
Other - Last Name:WHITTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:22210 HINKLE RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6838
Mailing Address - Country:US
Mailing Address - Phone:317-509-6506
Mailing Address - Fax:
Practice Address - Street 1:22210 HINKLE RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-6838
Practice Address - Country:US
Practice Address - Phone:317-877-9714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002570A207Q00000X, 2086S0129X, 202K00000X
MI5101015888202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77898Medicare UPIN
203960AMedicare ID - Type Unspecified