Provider Demographics
NPI:1164278891
Name:WHITE, PHILIP G
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27435 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7410
Mailing Address - Country:US
Mailing Address - Phone:313-215-3181
Mailing Address - Fax:
Practice Address - Street 1:6568 JOHN E HUNTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-1344
Practice Address - Country:US
Practice Address - Phone:313-215-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider