Healthcare Provider Details

I. General information

NPI: 1770531956
Provider Name (Legal Business Name): JAMES C CLANAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/21/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 CROSS STREET SUITE 330
SHILOH IL
62269-2998
US

IV. Provider business mailing address

1414 CROSS STREET SUITE 330
SHILOH IL
62269-2998
US

V. Phone/Fax

Practice location:
  • Phone: 618-277-7400
  • Fax: 618-277-7422
Mailing address:
  • Phone: 618-277-7400
  • Fax: 618-277-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036076994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: