Provider Information for 1720652431
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Mr. MICHAEL D WITHAM LPC
Sex: Male
NPI: 1720652431
Last Updated: 2021-05-17
Certification Date: 2021-05-17
Certification Date: 2021-05-17
Details
| Name | Value | ||||||||
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| NPI | 1720652431 | ||||||||
| Enumeration Date | 2021-05-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 206 E 3RD ST DELL RAPIDS, SD 57022-1916 United States Phone: 605-212-6902 | Fax: | ||||||||
| Primary Practice Address | 206 E 3RD ST DELL RAPIDS, SD 57022-1916 United States Phone: 605-212-6902 | Fax: | ||||||||
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