Provider Demographics
NPI:1114524485
Name:MARCIE A. CLAYBON MD PLLC
Entity Type:Organization
Organization Name:MARCIE A. CLAYBON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLAYBON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-280-0088
Mailing Address - Street 1:805 N. LASALLE DRIVE
Mailing Address - Street 2:APARTMENT 1204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:513-280-0088
Mailing Address - Fax:
Practice Address - Street 1:600 W. CHICAGO AVE.
Practice Address - Street 2:SUITE 001
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:312-625-0845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty