Provider Demographics
NPI:1578008793
Name:WHITMAN, KEVIN M
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:WHITMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BARRETT DR UNIT 115
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-7005
Mailing Address - Country:US
Mailing Address - Phone:585-456-8394
Mailing Address - Fax:585-299-9825
Practice Address - Street 1:75 BARRETT DR UNIT 115
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-7005
Practice Address - Country:US
Practice Address - Phone:585-456-8394
Practice Address - Fax:585-299-9825
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2023-10-02
Deactivation Date:2021-08-26
Deactivation Code:
Reactivation Date:2021-12-22
Provider Licenses
StateLicense IDTaxonomies
NY447603207PE0004X
NYMD-STUDENT390200000X, 390200000X, 390200000X
NYRESIDENT207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program