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NPI Code Detail

MEDICARE: CLYNIECE LOIS WATSON M.D.

MEDICARE: CLYNIECE LOIS WATSON 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
1208000000XPediatrics PhysicianIL

General Provider Information

NPI Number : 1316919061
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLYNIECE LOIS WATSON M.D.
Provider Business Mailing Address
First Line : 500 E 51ST ST
Second Line : DEPARTMENT OF PEDIATRICS
City : CHICAGO
State : IL
Zip : 60615-2400
Country : US
Telephone Number : 312-572-2696
Fax Number : 312-572-2686
Provider Business Practice Location Address
First Line : 500 E 51ST ST
Second Line : DEPARTMENT OF PEDIATRICS
City : CHICAGO
State : IL
Zip : 60615-2400
Country : US
Telephone Number : 312-572-2696
Fax Number : 312-572-2686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 07/08/2007

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