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General NPI Number Information
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NPI Number | 1255427779
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Entity Type | Individual
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Provider Name | DEBORAH S CLEMENTS M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 1275 E BELVIDERE RD SUITE 250
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2082
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Country | US
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Telephone | 847-926-0106
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Fax |
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Provider Business Mailing Address
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Address Line | 710 N LAKE SHORE DR ABBOTT HALL, 4TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60611-3006
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Country | US
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Telephone | 312-503-1275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-28569
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License Number State | KS
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