Provider Demographics
NPI:1295720795
Name:WHITELEY, MICHAEL JOE (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOE
Last Name:WHITELEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29214 QUINN RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4486
Mailing Address - Country:US
Mailing Address - Phone:281-351-4208
Mailing Address - Fax:281-351-5417
Practice Address - Street 1:29214 QUINN RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4486
Practice Address - Country:US
Practice Address - Phone:281-351-4208
Practice Address - Fax:281-351-5417
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45DO8899310OtherCLIA #
TX0718145OtherNAIS #
TX032573001Medicaid
TXF2109OtherSTATE LICENSE
TXH0048255OtherDPS #
TXH0048255OtherDPS #
TX000CW80Medicare ID - Type Unspecified
TX032573001Medicaid