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Individual

JERMAINE KYONG WHITE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637
(773) 702-9500
Mailing address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 702-9500

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036.139117
IL
207P00000X
Emergency Medicine Physician
125-059996
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036139117
IL
01
F400464740
MEDICARE PTAN
IL
Enumeration date
07/07/2011
Last updated
09/05/2018
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