Provider Demographics
NPI:1649419763
Name:WHITE, MICHAEL HOWARD (NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HOWARD
Last Name:WHITE
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 W QUAIL RUN LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-7748
Mailing Address - Country:US
Mailing Address - Phone:812-801-4329
Mailing Address - Fax:
Practice Address - Street 1:2580 MICHIGAN RD STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2492
Practice Address - Country:US
Practice Address - Phone:812-273-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001213A237700000X
KY0937237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist