Healthcare Provider Details

I. General information

NPI: 1013983618
Provider Name (Legal Business Name): DAVID H WHITNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 S HARLEM AVE SUITE 1A
BERWYN IL
60402-3073
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 262-898-4400
  • Fax: 708-788-6884
Mailing address:
  • Phone: 866-630-9882
  • Fax: 920-682-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036-063522
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: