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General NPI Number Information
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NPI Number | 1831344373
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Entity Type | Individual
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Provider Name | MARCIE ANN CLAYBON MD
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Gender | Female
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 11/05/2020
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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 | 60654-2802
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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 | 600 W. CHICAGO AVE. SUITE 001
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City | CHICAGO
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State | IL
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Zip | 60654-2802
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Country | US
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Telephone | 312-625-0845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 036.138794
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License Number State | IL
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