Healthcare Provider Details

I. General information

NPI: 1447186960
Provider Name (Legal Business Name): CLOVER CLINICAL NETWORK PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MID AMERICA PLZ
OAKBROOK TERRACE IL
60181-4450
US

IV. Provider business mailing address

1 MID AMERICA PLZ
OAKBROOK TERRACE IL
60181-4450
US

V. Phone/Fax

Practice location:
  • Phone: 630-566-8491
  • Fax:
Mailing address:
  • Phone: 630-566-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MARASIGAN
Title or Position: DIRECTOR OF GROWTH AND DEVELOPMENT
Credential:
Phone: 630-566-8491