Individual
KIMBERLY B WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 TUSCOLA BLVD, SBL TUSCOLA CLINIC, TUSCOLA, IL 61953
(217) 253-2020
(217) 253-2023
Mailing address
1005 HEALTH CENTER DR STE 201, MATTOON, IL 61938-4693
(217) 238-6055
(217) 258-2216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036125554
IL
207Q00000X
Family Medicine Physician
5901
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036125554
—
IL
Enumeration date
05/01/2007
Last updated
01/09/2019
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