Provider Demographics
NPI:1245689306
Name:WHITMAN, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 WISCONSIN ST
Mailing Address - Street 2:APT 2
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-5763
Mailing Address - Country:US
Mailing Address - Phone:989-708-0830
Mailing Address - Fax:
Practice Address - Street 1:2124 WISCONSIN ST
Practice Address - Street 2:APT 2
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-5763
Practice Address - Country:US
Practice Address - Phone:989-708-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor