Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 26620 | MN |
Y | 208000000X | Pediatrician | 26620 | MN |
NPI | 1588735005 |
---|---|
Provider Name | Dr. Chester B Whitley |
First Address | Minneapolis, MN 55414-2924 |
Second Address | Minneapolis, MN 55455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 18/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0055369 | (05) | MT |
0963116 | (05) | IA |
1009355 | PREFERREDONE (01) | |
100956 | UCARE (01) | |
1224617 | MEDICA - CHOICE (01) | |
1270277 | MEDICA - PRIMARY (01) | |
2T335WH | BLUE CROSS BLUE SHIELD (01) | |
604688 | ARAZ (01) | |
711378100 | (05) | MN |
D82149 | (02) | |
HP14681 | HEALTHPARTNERS (01) |