Provider Demographics
NPI:1477641280
Name:WHITEC, INC
Entity Type:Organization
Organization Name:WHITEC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1708-560-1960
Mailing Address - Street 1:7318 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-3100
Mailing Address - Country:US
Mailing Address - Phone:708-560-1960
Mailing Address - Fax:
Practice Address - Street 1:7318 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-3100
Practice Address - Country:US
Practice Address - Phone:708-560-1960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087476208D00000X, 2083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087476Medicaid
IL0001636851OtherBLUE CROSS/BLUE SHIELD
IL036087476Medicaid