Healthcare Provider Details

I. General information

NPI: 1407768922
Provider Name (Legal Business Name): DURRELL D CLINKSCALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7229 S MERRILL AVE
CHICAGO IL
60649-3007
US

IV. Provider business mailing address

7229 S MERRILL AVE
CHICAGO IL
60649-3007
US

V. Phone/Fax

Practice location:
  • Phone: 773-569-9676
  • Fax:
Mailing address:
  • Phone: 773-569-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: