MEDICARE: DR. AISHA DALILA WHITE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	N4200	TX
2	208200000X	Plastic Surgery Physician	N4200	TX
3	2086S0122X	Plastic and Reconstructive Surgery Physician	N4200	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	721089	OTHER	IL	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3932056	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1255589180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AISHA DALILA WHITE M.D.

Provider Business Mailing Address
First Line	:	6611 RIVER PLACE BLVD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730-1167
Country	:	US
Telephone Number	:	512-777-2969
Fax Number	:	512-777-0861

Provider Business Practice Location Address
First Line	:	6611 RIVER PLACE BLVD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730-1167
Country	:	US
Telephone Number	:	512-324-8320
Fax Number	:	512-324-8323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	07/25/2019

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