Provider Demographics
NPI:1841463999
Name:WHITMORE, NATHAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:DAVID
Last Name:WHITMORE
Suffix:
Gender:M
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:300 HIGH POINT CT
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6560
Practice Address - Country:US
Practice Address - Phone:502-955-6129
Practice Address - Fax:502-955-8161
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45443208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK059800OtherMEDICARE- NORTON MEDICAL ASSOCIATES
KY7100134070Medicaid