Provider Demographics
NPI:1598796708
Name:WHITING, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:WHITING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14775 N KIMO CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8762
Mailing Address - Country:US
Mailing Address - Phone:208-687-5627
Mailing Address - Fax:208-687-5628
Practice Address - Street 1:913 W CANFIELD AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9764
Practice Address - Country:US
Practice Address - Phone:208-819-7103
Practice Address - Fax:208-763-3203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2020-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM8126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010029526OtherREGENCE BLUE SHIELD HS65
WA171111OtherLABOR AND INDUSTRIES
IDG04615Medicare UPIN