Healthcare Provider Details

I. General information

NPI: 1376906164
Provider Name (Legal Business Name): WHITNEY MICHELLE DAWSON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12935 GREGORY ST
BLUE ISLAND IL
60406
US

IV. Provider business mailing address

215 W LAKE ST APT 805
CHICAGO IL
60606-1862
US

V. Phone/Fax

Practice location:
  • Phone: 708-597-2000
  • Fax:
Mailing address:
  • Phone: 803-497-2381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.149523
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.149523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: