Provider Demographics
NPI:1912976978
Name:WHITAKER BAY, TAMARA MARIE (DPM)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:MARIE
Last Name:WHITAKER BAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 HOWARD STREET
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1917
Mailing Address - Country:US
Mailing Address - Phone:269-385-1000
Mailing Address - Fax:269-385-5120
Practice Address - Street 1:515 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1917
Practice Address - Country:US
Practice Address - Phone:269-385-1000
Practice Address - Fax:269-385-5120
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITW002034213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7287715OtherAETNA
2730125OtherUHC IBA
MI4685152Medicaid
480C912300OtherBCBSM
522456150OtherTRICARE
480C912300OtherBCBSM
MI4685152Medicaid