MEDICARE: DR. DAVID H WHITNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	036-063522	IL

General Provider Information

NPI Number	:	1013983618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID H WHITNEY MD

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	866-630-9882
Fax Number	:	920-682-5810

Provider Business Practice Location Address
First Line	:	3253 S HARLEM AVE
Second Line	:	SUITE 1A
City	:	BERWYN
State	:	IL
Zip	:	60402-3073
Country	:	US
Telephone Number	:	262-898-4400
Fax Number	:	708-788-6884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	11/22/2016

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