Provider Demographics
NPI:1205971165
Name:WHALEY, STEVEN DALE (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DALE
Last Name:WHALEY
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 1:51033 HUNTINGTON LN
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8813
Mailing Address - Country:US
Mailing Address - Phone:574-271-0436
Mailing Address - Fax:
Practice Address - Street 1:4111 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7803
Practice Address - Country:US
Practice Address - Phone:219-476-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010347562083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28505Medicare ID - Type UnspecifiedMEDICARE
IN940970Medicare UPIN