Individual
G WESLEY WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25 N WINFIELD RD, OPS BUILDING, SUITE 507, WINFIELD, IL 60190-1295
(630) 933-5518
(630) 933-4168
Mailing address
25 N WINFIELD RD, OPS BUILDING, SUITE 507, WINFIELD, IL 60190-1295
(630) 933-5518
(630) 933-4168
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036051494
IL
207RI0200X
Infectious Disease Physician
Primary
036051494
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635822
BCBS PROVIDER ID
IL
05
—
036051494
—
IL
01
—
206147
MEDICARE PTAN (GROUP
IL
01
—
K49356
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P00448441
RAILROAD MEDICARE
IL
01
—
P00661626
RR MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
05/31/2006
Last updated
12/27/2013
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