Provider Demographics
NPI:1336151695
Name:WHYTE, STEPHANIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:WHYTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 S WOLCOTT AVE
Mailing Address - Street 2:SUITE 1S MOBILE CARE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4340
Mailing Address - Country:US
Mailing Address - Phone:773-890-7130
Mailing Address - Fax:773-247-9384
Practice Address - Street 1:2244 S WOLCOTT AVE
Practice Address - Street 2:SUITE 1S MOBILE CARE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4340
Practice Address - Country:US
Practice Address - Phone:773-890-7130
Practice Address - Fax:773-247-9384
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH10824Medicare UPIN