Healthcare Provider Details

I. General information

NPI: 1508071903
Provider Name (Legal Business Name): T CLARBOUR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 RANDOLPH ST SUITE 2
OAK PARK IL
60302-3453
US

IV. Provider business mailing address

1033 RANDOLPH ST SUITE 2
OAK PARK IL
60302-3453
US

V. Phone/Fax

Practice location:
  • Phone: 708-955-8033
  • Fax: 708-445-8444
Mailing address:
  • Phone: 708-955-8033
  • Fax: 708-445-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TERRY CLARBOUR
Title or Position: MEMBER
Credential: MD
Phone: 708-955-8033