Provider Demographics
NPI:1467600155
Name:WHITE, ALISHA ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:ALLEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4 COUNTRY CLUB EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1702
Mailing Address - Country:US
Mailing Address - Phone:618-659-5567
Mailing Address - Fax:618-391-7117
Practice Address - Street 1:4 COUNTRY CLUB EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1702
Practice Address - Country:US
Practice Address - Phone:618-659-5567
Practice Address - Fax:618-391-7117
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.121823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine