Healthcare Provider Details

I. General information

NPI: 1043847734
Provider Name (Legal Business Name): EMMA C CLARDY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 BOND AVE
CENTREVILLE IL
62207-2328
US

IV. Provider business mailing address

2401 S CENTER ST
MARYVILLE IL
62062-5401
US

V. Phone/Fax

Practice location:
  • Phone: 618-337-8153
  • Fax: 618-337-8905
Mailing address:
  • Phone: 618-344-3046
  • Fax: 618-344-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036163844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: