Organization
DR. MARY WHITE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY WHITE (OWNER)
(815) 282-4000
Entity
Organization
Contact information
Practice address
6451 E RIVERSIDE BLVD, STE 104, ROCKFORD, IL 61114-4421
(815) 282-4000
Mailing address
6451 E RIVERSIDE BLVD, STE 104, ROCKFORD, IL 61114-4421
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004011
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO9332
RAILROAD MEDICARE
IL
Enumeration date
05/31/2007
Last updated
11/29/2022
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