Provider Demographics
NPI:1619060787
Name:WHITHAUS, KENNETH CLIFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CLIFFORD
Last Name:WHITHAUS
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 1:1899 EIDER COURT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4537
Mailing Address - Country:US
Mailing Address - Phone:850-219-7640
Mailing Address - Fax:
Practice Address - Street 1:1899 EIDER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4537
Practice Address - Country:US
Practice Address - Phone:850-219-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR9321390200000X
ALMD.29340207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 109950OtherME LICENCE NUMBER