Provider Demographics
NPI:1386905446
Name:WHITMER, STEPHANIE K (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:WHITMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:K
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:725 SCHOOL ST
Mailing Address - Street 2:STE A
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1345 EDWARDS ST STE 2
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1692
Practice Address - Country:US
Practice Address - Phone:815-942-1421
Practice Address - Fax:815-488-2033
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47379207Q00000X
IL036.147749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK102765OtherKY MEDICARE
KY7100253110Medicaid
IL036147749OtherIL LICENSE
KYK102761Medicare PIN
KYK102760Medicare PIN