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NPI Code Detail

MEDICARE: DR. DESMOND THOMAS WHITE M.D.

MEDICARE: DR. DESMOND THOMAS 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
1208D00000XGeneral Practice Physician036.054369IL

General Provider Information

NPI Number : 1427317262
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DESMOND THOMAS WHITE M.D.
Provider Business Mailing Address
First Line : 620 UNITY CT
Second Line :
City : SHOREWOOD
State : IL
Zip : 60404-9595
Country : US
Telephone Number : 181-558-2432
Fax Number :
Provider Business Practice Location Address
First Line : 213 E CASS ST
Second Line :
City : JOLIET
State : IL
Zip : 60432-2812
Country : US
Telephone Number : 815-726-3377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2012
Last Update Date : 05/14/2012

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Directions to “ DR. DESMOND THOMAS WHITE M.D.” Practice Location

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