Provider Demographics
NPI:1730290941
Name:WHITE, JOHN V (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:WHITE
Suffix:
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 1:8816 DEMPSTER
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-518-1762
Mailing Address - Fax:847-723-3007
Practice Address - Street 1:8816 DEMPSTER
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-518-1762
Practice Address - Fax:847-723-3007
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360672912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067291Medicaid
IL0001632574OtherBCBS
IL0001632574OtherBCBS
203462Medicare ID - Type Unspecified