Provider Demographics
NPI:1699878066
Name:WHITFIELD, CAROLYN (DPM)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16151 WEBER RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0863
Mailing Address - Country:US
Mailing Address - Phone:815-733-5162
Mailing Address - Fax:815-733-5192
Practice Address - Street 1:16151 WEBER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0863
Practice Address - Country:US
Practice Address - Phone:815-733-5162
Practice Address - Fax:815-733-5192
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003971213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0060001542OtherBCBS
IL016003971Medicaid
ILK08611Medicare PIN
T38600Medicare UPIN
IL016003971Medicaid
IL0301560001Medicare NSC