Provider Demographics
NPI:1265548903
Name:WHITE, XAVIER (MD)
Entity type:Individual
Prefix:
First Name:XAVIER
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:313-832-0870
Mailing Address - Fax:313-832-6024
Practice Address - Street 1:3800 WOODWARD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2061
Practice Address - Country:US
Practice Address - Phone:313-832-0870
Practice Address - Fax:313-832-6024
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIXW4053762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10043320001OtherWELLNESS PLAN
MI103421OtherGREAT LAKES HMO
MIXW405376OtherSTATE LICENSE NUMBER
MI2093489OtherCIGNA HEALTH INSURANCE
MIG22932OtherHEALTH ALLIANCE PLAN
MI3242604Medicaid
MIP00082403OtherTRAVELERS RAILROAD MEDICA
MIG22932Medicare UPIN