Individual
MR. LARRY KEITH WHITAKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
801 E ORANGE ST, HOOPESTON COMMUNITY MEMORIAL HOSPITAL DBA CHARLOTTE ANN, HOOPESTON, IL 60942-1802
(217) 283-5644
(217) 283-7432
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085002299
IL
363AM0700X
Medical Physician Assistant
Primary
085002299
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085002299
LICENSE NUMBER
IL
01
—
096466
HEALTH ALLIANCE
IL
01
—
777561
HEALTH LINK
IL
Enumeration date
06/16/2006
Last updated
06/09/2025
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