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General NPI Number Information
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NPI Number | 1861676538
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Entity Type | Individual
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Provider Name | CORDIA MARIE CLARK-WHITE MD
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Gender | Female
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 1645 W JACKSON BLVD STE 310
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City | CHICAGO
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State | IL
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Zip | 60612-3227
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Country | US
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Telephone | 312-942-8060
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Fax | 312-942-8222
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Provider Business Mailing Address
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Address Line | 3473 S KING DR # 472
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City | CHICAGO
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State | IL
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Zip | 60616-4108
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Country | US
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Telephone | 708-207-3639
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-119447
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License Number State | IL
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