Healthcare Provider Details

I. General information

NPI: 1487912721
Provider Name (Legal Business Name): CLIFFORD SONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 HALIGUS RD FL 2
HUNTLEY IL
60142-9553
US

IV. Provider business mailing address

1210 LARRABEE ST # 8
WEST HOLLYWOOD CA
90069-6104
US

V. Phone/Fax

Practice location:
  • Phone: 224-654-0000
  • Fax: 224-654-0000
Mailing address:
  • Phone: 703-585-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number76210
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC193443
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036170016
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: