Basic Information
| Provider Information | |||||||||
| NPI: | 1871848853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 FOREST PARK AVE, 2ND FLOOR MEDICINE CLINIC | ||||||||
| Address2: | CENTER FOR OUTPATIENT HEALTH | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63108 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 875 PRE EMPTION RD STE 4 | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144562042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853686545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084H0002X | 301718 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Hospice and Palliative Medicine | 2084N0400X | 2012018828 | MO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.