Provider Demographics
NPI:1851469274
Name:WHICHDR ENTERPRISES LTD
Entity Type:Organization
Organization Name:WHICHDR ENTERPRISES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:708-922-1108
Mailing Address - Street 1:18600 GOLF LN
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429
Mailing Address - Country:US
Mailing Address - Phone:708-922-1108
Mailing Address - Fax:
Practice Address - Street 1:1820 RIDGE RD STE 301
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1759
Practice Address - Country:US
Practice Address - Phone:708-922-1108
Practice Address - Fax:708-922-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360927202086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623278OtherBCBS
IL21623278OtherBCBS