Provider Demographics
NPI:1831344373
Name:CLAYBON, MARCIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:ANN
Last Name:CLAYBON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W. CHICAGO AVE.
Mailing Address - Street 2:SUITE 001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-2802
Mailing Address - Country:US
Mailing Address - Phone:312-625-0845
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:60654-2802
Practice Address - Country:US
Practice Address - Phone:312-625-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.138794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000OtherPRACTICE IS NOT INSURANCE-BASED
IL1831344373OtherNPI
IL036.138794OtherIL LICENSE #