Clark, Michael
Clark, Michael is an individual health care provider with primary practice located at 2160 S 1St Ave 101-1740 Loyola University Medical Center, Maywood IL 60153. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Clark, Michael can be contacted via phone (708) 216-9000.Contact Information
Primary practice address
2160 S 1St Ave 101-1740 Loyola University Medical Center
Maywood IL 60153
Phone: (708) 216-9000
Fax: (708) 216-9033
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 36080197 | Illinois |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 36080197 | Illinois |
Profile Details
| NPI number | 1033185434 |
|---|---|
| LBN Legal business name | Clark, Michael |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 24th, 2006 |
| Last updated | Jun 24th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033185434 | NPPES |
| Illinois | MEDICAID | 36080197 |
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