Provider Demographics
NPI:1336217496
Name:WHITE, LOUIS ELDEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ELDEAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 HORTON RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5594
Mailing Address - Country:US
Mailing Address - Phone:517-788-8251
Mailing Address - Fax:517-788-8704
Practice Address - Street 1:1931 HORTON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5594
Practice Address - Country:US
Practice Address - Phone:517-788-8251
Practice Address - Fax:517-788-8704
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000896213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2102153Medicaid
MI4853851270OtherBCBSM
MI1336OtherHEALTH PLAN OF MICHIGAN
MI2728009OtherPHYSICIANS HEALTH PLAN
MI1336OtherHEALTH PLAN OF MICHIGAN
MIT33986Medicare UPIN
MI0370180001Medicare NSC