Clark, Todd

Clark, Todd is an individual health care provider with primary practice located at 1775 W Dempster St 1 West, Park Ridge IL 60068-1143. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Emergency Medical Services. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Clark, Todd can be contacted via phone (847) 723-5150.

Contact Information

Primary practice address
1775 W Dempster St 1 West Park Ridge IL 60068-1143
Phone: (847) 723-5150
Fax: (847) 723-2083
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X A84896 California
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X A84896 California
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 036-107180 Illinois
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-107180 Illinois

Profile Details

NPI number 1073504767
LBN Legal business name Clark, Todd
Credentials MEDICAL DOCTOR
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Sep 19th, 2022 - about 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073504767 NPPES
California MEDICAID 00A84896
California MEDICAID 00A848960

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