Provider Demographics
NPI:1477554939
Name:WHITTINGTON, JEREMIAH (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3230
Mailing Address - Country:US
Mailing Address - Phone:248-865-4220
Mailing Address - Fax:248-865-4103
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 270
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-865-4220
Practice Address - Fax:248-865-4103
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301042551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104504490Medicaid
MI160631551OtherBCBS
MI292636410Medicaid
D35405OtherHAP
MI104504490Medicaid
MI160631551OtherBCBS
MID35405Medicare UPIN