Individual
ROBERT WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
10 W 3RD ST, STERLING, IL 61081-3503
(815) 625-4790
Mailing address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045382
HEALTH ALLIANCE PLAN
IL
01
—
9815737
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/16/2006
Last updated
07/08/2007
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