Provider Demographics
NPI:1245633619
Name:CARL G WHETSELL,MD,PA
Entity type:Organization
Organization Name:CARL G WHETSELL,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHETSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-442-1740
Mailing Address - Street 1:4131 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2057
Mailing Address - Country:US
Mailing Address - Phone:305-442-1740
Mailing Address - Fax:305-442-2207
Practice Address - Street 1:16201 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4607
Practice Address - Country:US
Practice Address - Phone:305-442-1740
Practice Address - Fax:305-442-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116586261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care