Provider Demographics
NPI:1417092602
Name:WHYTE, KIRK R (DO)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:R
Last Name:WHYTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1673
Mailing Address - Country:US
Mailing Address - Phone:248-338-5443
Mailing Address - Fax:
Practice Address - Street 1:130 SEMINOLE ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1673
Practice Address - Country:US
Practice Address - Phone:248-338-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015911207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine