Provider Demographics
NPI:1932190634
Name:WHITE, JACQUELINE D (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-799-8880
Mailing Address - Fax:708-799-8991
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:STE 102
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-799-8880
Practice Address - Fax:708-799-8991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12988Medicare UPIN
IL709950Medicare ID - Type Unspecified