Individual
A JEFFREY WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3524 E MILWAUKEE ST, JANESVILLE, WI 53546-1626
(608) 756-7100
(608) 756-4700
Mailing address
3524 E MILWAUKEE ST, JANESVILLE, WI 53546-1626
(608) 756-7100
(608) 756-4700
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
47003
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34551500
—
WI
01
—
P00942387DB7792
RR MEDICARE
WI
01
—
WHITEJE4
MERCYCARE INSURANCE
WI
Enumeration date
02/24/2006
Last updated
09/10/2012
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