Provider Demographics
NPI:1013917442
Name:WHITE, TIMOTHY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:WHITE
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 1:4520 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7941
Mailing Address - Country:US
Mailing Address - Phone:269-969-8723
Mailing Address - Fax:269-969-8724
Practice Address - Street 1:4520 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7941
Practice Address - Country:US
Practice Address - Phone:269-969-8723
Practice Address - Fax:269-969-8724
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350A349860OtherBLUE CROSS BLUE SHIELD
MI104487755Medicaid
MI151419OtherGREAT LAKES HEALTH PLAN
MI25193OtherHEALTH PLAN OF MICHIGAN
MI12-30369OtherUNITED HEALTHCARE
MI7277005OtherAETNA
MIG99960Medicare UPIN
MI7277005OtherAETNA