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General NPI Number Information
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NPI Number | 1588735005
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Entity Type | Individual
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Provider Name | CHESTER B WHITLEY MD
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | UNIVERSITY OF MINNESOTA PHYSICIANS 516 DELAWARE STREET SE, ROOM 4-100
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-626-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 720 WASHINGTON AVE SE UNIVERSITY OF MINNESOTA PHYSICIANS
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-2924
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Country | US
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Telephone | 612-884-0649
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 26620
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 26620
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License Number State | MN
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