Provider Demographics
NPI:1134106024
Name:WHITE, NATHAN S (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:S
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:877-996-9975
Mailing Address - Fax:586-228-4533
Practice Address - Street 1:21000 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1116
Practice Address - Country:US
Practice Address - Phone:586-447-5100
Practice Address - Fax:586-447-5090
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2008-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070798207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4755678Medicaid
MI0E01168OtherBCBS GROUP NUMBER
H64530Medicare UPIN
MIM92780010Medicare UPIN
MI0M92780Medicare PIN