Healthcare Provider Details

I. General information

NPI: 1508821935
Provider Name (Legal Business Name): DONNA I WHITTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 436
MILWAUKEE WI
53215-3693
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3577
  • Fax:
Mailing address:
  • Phone: 414-649-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number48044-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: