Healthcare Provider Details

I. General information

NPI: 1336151695
Provider Name (Legal Business Name): STEPHANIE A WHYTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 S WOLCOTT AVE SUITE 1S MOBILE CARE
CHICAGO IL
60608-4340
US

IV. Provider business mailing address

2244 S WOLCOTT AVE SUITE 1S MOBILE CARE
CHICAGO IL
60608-4340
US

V. Phone/Fax

Practice location:
  • Phone: 773-890-7130
  • Fax: 773-247-9384
Mailing address:
  • Phone: 773-890-7130
  • Fax: 773-247-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: