Individual
DR. MARY C WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
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
—
4760030001
DMERC
IL
01
—
60101278
BC/BS
IL
01
—
P00050197
RAILROAD MEDICARE
IL
Enumeration date
07/26/2006
Last updated
11/29/2022
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