Provider Demographics
NPI:1578604567
Name:WHITE, HERBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-0185
Mailing Address - Country:US
Mailing Address - Phone:708-819-0007
Mailing Address - Fax:812-485-6909
Practice Address - Street 1:879 JOLIET ST
Practice Address - Street 2:#184
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1920
Practice Address - Country:US
Practice Address - Phone:812-485-6900
Practice Address - Fax:812-485-6909
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037649207R00000X, 2083P0500X
IL036-073679207R00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine