MEDICARE: DR. DONALD L WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1548470545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD L WHITE

Provider Business Mailing Address
First Line	:	330 W DIVERSEY PKWY
Second Line	:	1803
City	:	CHICAGO
State	:	IL
Zip	:	60657-6262
Country	:	US
Telephone Number	:	773-296-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3819
Country	:	US
Telephone Number	:	773-791-0035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/23/2008

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