Healthcare Provider Details

I. General information

NPI: 1851661862
Provider Name (Legal Business Name): SUSIE MARIA WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSIE MARIA LI M.D.

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 RANDALL RD
GENEVA IL
60134-4200
US

IV. Provider business mailing address

304 RANDALL RD
GENEVA IL
60134-4200
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-0610
  • Fax: 630-232-0675
Mailing address:
  • Phone: 630-232-0610
  • Fax: 630-232-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number036083093
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number036083093
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32474
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: