Individual
PENNY LA RUTH WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
115 N PARKSIDE AVE, CHICAGO, IL 60644-3040
(773) 295-3060
Mailing address
3 ERIE CT STE 7140, OAK PARK, IL 60302-2519
(773) 537-0020
(773) 537-0029
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
00012637
AL
208000000X
Pediatrics Physician
Primary
036122437
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
630900034
—
AL
05
—
630901034
—
AL
05
—
630902034
—
AL
05
—
630903034
—
AL
05
—
630904034
—
AL
Enumeration date
07/26/2006
Last updated
01/03/2020
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