Provider Information for 1164977807
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DEHVIN WHITE-PECK
Sex: Male
NPI: 1164977807
Last Updated: 2023-10-16
Certification Date: 2023-10-16
Certification Date: 2023-10-16
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1164977807 | ||||||||
| Enumeration Date | 2016-08-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1324 HARVEST DR CREST HILL, IL 60403-0956 United States Phone: 770-510-6469 | Fax: | ||||||||
| Primary Practice Address | 1324 HARVEST DR CREST HILL, IL 60403-0956 United States Phone: 770-510-6469 | Fax: | ||||||||
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