Basic Information
| Provider Information | |||||||||
| NPI: | 1568876597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITNEY | ||||||||
| FirstName: | CHARIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 W MINNEZONA AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157380786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3333 E CAMELBACK RD STE 180 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850182396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029970484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD461939 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | TRN28176 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | TRN28176 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 103332830 | 05 | PA | MEDICAID |