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General NPI Number Information
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NPI Number | 1689406399
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Entity Type | Organization
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Legal Business Name | DOCTOR BY DESIGN, LLC
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 6835 SOUTH CHAPPEL AVE
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City | CHICAGO
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State | IL
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Zip | 60649
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Country | US
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Telephone | 773-418-0860
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Fax | 580-200-3580
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Provider Business Mailing Address
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Address Line | 1440 W TAYLOR ST # 2809
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City | CHICAGO
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State | IL
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Zip | 60607-4623
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Country | US
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Telephone | 773-418-0860
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Fax | 580-200-3580
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Authorized Official
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Title or Position | OWNER/LEAD PHYSICIAN
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Name | DR. KORTNEE ROBERSON COOPER
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Credential | MD
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Telephone | 773-418-0860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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