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General NPI Number Information
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NPI Number | 1114524485
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Entity Type | Organization
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Legal Business Name | MARCIE A. CLAYBON MD PLLC
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 600 W. CHICAGO AVE. SUITE 001
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-625-0845
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N. LASALLE DRIVE APARTMENT 1204
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City | CHICAGO
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State | IL
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Zip | 60610
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Country | US
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Telephone | 513-280-0088
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN, MEDICAL DIRECTOR
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Name | DR. MARCIE ANN CLAYBON
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Credential | MD
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Telephone | 513-280-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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