MEDICARE: RICHARD R. CLARK M.D.

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
1	207Q00000X	Family Medicine Physician	38607	WI
2	207Q00000X	Family Medicine Physician	003-036-082187-01	IL

General Provider Information

NPI Number	:	1023042470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD R. CLARK M.D.

Provider Business Mailing Address
First Line	:	1475 E BELVIDERE RD UNIT 385
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-2026
Country	:	US
Telephone Number	:	847-535-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 E BELVIDERE RD UNIT 385
Second Line	:
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-2026
Country	:	US
Telephone Number	:	847-535-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/12/2019

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Directions to “ RICHARD R. CLARK M.D.” Practice Location

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