Provider Demographics
NPI:1710769013
Name:WHITMORE, MICHAEL RANDOLPH (CDCA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RANDOLPH
Last Name:WHITMORE
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3484 CINCINNATI ZANESVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9308
Mailing Address - Country:US
Mailing Address - Phone:614-991-0131
Mailing Address - Fax:
Practice Address - Street 1:3484 CINCINNATI ZANESVILLE RD NE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9308
Practice Address - Country:US
Practice Address - Phone:614-991-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-17773171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator