Individual
CORDIA MARIE CLARK-WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1645 W JACKSON BLVD STE 310, CHICAGO, IL 60612-3227
(312) 942-8060
(312) 942-8222
Mailing address
3473 S KING DR # 472, CHICAGO, IL 60616-4108
(708) 207-3639
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-119447
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036119447
—
IL
01
—
1619478
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/18/2007
Last updated
04/29/2021
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