Provider Demographics
NPI:1508813106
Name:WHISENANT, MICHAEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:WHISENANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 7TH AVE
Mailing Address - Street 2:450
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2349
Mailing Address - Country:US
Mailing Address - Phone:509-455-8820
Mailing Address - Fax:509-838-4978
Practice Address - Street 1:2315 8TH ST GRADE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:208-746-1383
Practice Address - Fax:208-298-0727
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9628207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8454886Medicaid
WAP00316149OtherRRB
ID807466400Medicaid
WAP00316149OtherRRB
ID807466400Medicaid
WAG8860401Medicare PIN
ID1133330Medicare PIN