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Individual

JOHN JOSEPH WHITE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1750 E LAKE SHORE DR, STE 200, DECATUR, IL 62521-3809
(217) 428-6300
(217) 428-6322
Mailing address
1750 E LAKE SHORE DR, STE 200, DECATUR, IL 62521-3809
(217) 428-6300
(217) 428-6322

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CI8411
MEDICARE TRAVELERS
Enumeration date
11/18/2005
Last updated
10/26/2007
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