Provider Demographics
NPI:1457339574
Name:WHITTY, CHRISTOPHER JAMES (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:WHITTY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6630
Mailing Address - Country:US
Mailing Address - Phone:734-225-7770
Mailing Address - Fax:734-225-7775
Practice Address - Street 1:17515 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6630
Practice Address - Country:US
Practice Address - Phone:734-225-7770
Practice Address - Fax:734-225-7775
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010784962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104754213Medicaid
MI202784777OtherFEDERAL TAX ID
MII36376Medicare UPIN
MI104754213Medicaid