Individual
JOHN A WHITNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2235 CLEVELAND RD, SOUTH BEND, IN 46628-3529
(574) 647-4530
(574) 647-2285
Mailing address
710 N. NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01076361A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247000017
MEDICARE PTAN
IN
05
—
300003017
—
IN
Enumeration date
06/13/2014
Last updated
02/23/2022
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