Provider Demographics
NPI:1689406399
Name:DOCTOR BY DESIGN, LLC
Entity type:Organization
Organization Name:DOCTOR BY DESIGN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KORTNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-418-0860
Mailing Address - Street 1:1440 W TAYLOR ST # 2809
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:773-418-0860
Mailing Address - Fax:580-200-3580
Practice Address - Street 1:6835 SOUTH CHAPPEL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:773-418-0860
Practice Address - Fax:580-200-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty