Healthcare Provider Details

I. General information

NPI: 1609688779
Provider Name (Legal Business Name): WHITTINGTON DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MACARTHUR BLVD STE 6
MUNSTER IN
46321-2917
US

IV. Provider business mailing address

800 MACARTHUR BLVD STE 6
MUNSTER IN
46321-2917
US

V. Phone/Fax

Practice location:
  • Phone: 219-398-4234
  • Fax:
Mailing address:
  • Phone: 219-398-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM WHITTINGTON
Title or Position: CEO
Credential: MD
Phone: 219-398-4234