Individual
WILLARD WHITEHEAD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 MULBERRY ST, EVANSVILLE, IN 47713-1230
(812) 423-7791
(812) 422-7558
Mailing address
415 MULBERRY ST, EVANSVILLE, IN 47713-1230
(812) 423-7791
(812) 422-7558
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01040185A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082157
ANTHEM
IN
01
—
01040185B
CSR
IN
05
—
100366260
—
IN
01
—
10787143
CAQH
IN
01
—
260031376
RAILROAD MEDICARE
IN
01
—
834950LLL
MEDICARE
IN
Enumeration date
08/14/2006
Last updated
03/07/2023
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