Provider Demographics
NPI:1740490200
Name:WHITFORD, MICHELLE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:WHITFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC-845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-5310
Mailing Address - Fax:616-391-5343
Practice Address - Street 1:100 MICHIGAN ST NE # MC-71
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-5310
Practice Address - Fax:616-391-5343
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72214207P00000X
NMMD2011-0109207P00000X
NV13667207PE0004X
MI4301088600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740490200Medicaid
MI0M33350Medicare PIN
NMNMAAA0773Medicare PIN
MI1740490200Medicaid