Provider Demographics
NPI:1245961895
Name:LOUIS I WHITE MD
Entity type:Organization
Organization Name:LOUIS I WHITE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ISADORE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-646-1775
Mailing Address - Street 1:1775 E 14 MILE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7204
Mailing Address - Country:US
Mailing Address - Phone:248-646-1775
Mailing Address - Fax:
Practice Address - Street 1:1775 E 14 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7204
Practice Address - Country:US
Practice Address - Phone:248-646-1775
Practice Address - Fax:248-646-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty