Provider Demographics
NPI:1568480044
Name:WHINNEY, ROBB ROUSSEAU (DO)
Entity Type:Individual
Prefix:
First Name:ROBB
Middle Name:ROUSSEAU
Last Name:WHINNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-1821
Mailing Address - Country:US
Mailing Address - Phone:815-943-5431
Mailing Address - Fax:715-843-1220
Practice Address - Street 1:901 GRANT ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-1821
Practice Address - Country:US
Practice Address - Phone:815-943-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014409207LC0200X, 2086S0127X, 208600000X, 2086S0102X
WI52369-212086S0127X
IL36.1106612086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245974217Medicaid
IL$$$$$$$$$Medicaid
WIWHINNROBOtherMERCYCARE INSURANCE
WI1568480044Medicaid
WIP0096388DB7792OtherRR MEDICARE
WI541760601Medicare UPIN
WI1568480044Medicaid
020052535Medicare PIN
WIP0096388DB7792OtherRR MEDICARE