Basic Information
| Provider Information | |||||||||
| NPI: | 1801138722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITLEY | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7232 DEPT 165 | ||||||||
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| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462077232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176149850 | ||||||||
| FaxNumber: | 3176149655 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 W 86TH ST | ||||||||
| Address2: | DEPARTMENT OF MEDICAL EDUCATION | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173382345 | ||||||||
| FaxNumber: | 8007310751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2013 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 01076557A | IN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.