Provider Demographics
NPI:1518120195
Name:WHATELEY, JASON CLEMENT (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CLEMENT
Last Name:WHATELEY
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 1:1135 W UNIVERSITY DR STE 225
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1890
Mailing Address - Country:US
Mailing Address - Phone:248-824-2570
Mailing Address - Fax:248-824-2571
Practice Address - Street 1:1135 W UNIVERSITY DR STE 225
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1890
Practice Address - Country:US
Practice Address - Phone:248-824-2570
Practice Address - Fax:248-824-2571
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315046405207R00000X
MI5315036655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518120195Medicaid