Basic Information
| Provider Information | |||||||||
| NPI: | 1023019106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITWORTH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17426 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337620426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275737777 | ||||||||
| FaxNumber: | 7275737710 | ||||||||
| Practice Location | |||||||||
| Address1: | 5380 TECH DATA DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337603122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275737777 | ||||||||
| FaxNumber: | 7275737710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME112089 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | IO665Z | 01 | FL | MEDICARE PTAN | OTHER |