Provider Demographics
NPI:1821017849
Name:WHITTLE, JEFFREY CLEMENT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CLEMENT
Last Name:WHITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PC/00 CLEMENT J ZABLOCKI VA MEDICAL CTR
Mailing Address - Street 2:5000 W. NATIONAL AVE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:414-382-5017
Practice Address - Street 1:PC/00 CLEMENT J ZABLOCKI VA MEDICAL CTR
Practice Address - Street 2:5000 W. NATIONAL AVE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-382-5017
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI48151-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI48151-020OtherMEDICAL LICENSE
KS011B147AMedicare ID - Type UnspecifiedMEDICARE #
C74341Medicare UPIN