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NPI Code Detail

MEDICARE: CLARK OLAVI ANDELIN MD

MEDICARE: CLARK OLAVI ANDELIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician2007019019MO
2207V00000XObstetrics & Gynecology Physician036148618IL

General Provider Information

NPI Number : 1013114453
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARK OLAVI ANDELIN MD
Provider Business Mailing Address
First Line : 1005 BROADWAY ST
Second Line :
City : QUINCY
State : IL
Zip : 62301-2834
Country : US
Telephone Number : 217-223-8400
Fax Number :
Provider Business Practice Location Address
First Line : 1005 BROADWAY ST
Second Line :
City : QUINCY
State : IL
Zip : 62301-2834
Country : US
Telephone Number : 217-223-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2007
Last Update Date : 01/13/2026

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Directions to “ CLARK OLAVI ANDELIN MD” Practice Location

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