Provider Demographics
NPI:1255889622
Name:CORDIA M. CLARK-WHITE, MD, LTD
Entity type:Organization
Organization Name:CORDIA M. CLARK-WHITE, MD, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CORDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-326-1792
Mailing Address - Street 1:2600 S MICHIGAN AVE
Mailing Address - Street 2:305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2857
Mailing Address - Country:US
Mailing Address - Phone:312-326-1792
Mailing Address - Fax:312-326-1200
Practice Address - Street 1:2600 S MICHIGAN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2857
Practice Address - Country:US
Practice Address - Phone:312-326-1792
Practice Address - Fax:312-326-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036119447207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty