MEDICARE: CLARK MCCLURKIN 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	207RN0300X	Nephrology Physician	036078948	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184604282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARK MCCLURKIN M.D.

Provider Business Mailing Address
First Line	:	210 S DESPLAINES ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5500
Country	:	US
Telephone Number	:	312-654-2700
Fax Number	:	312-654-9930

Provider Business Practice Location Address
First Line	:	10801 S WESTERN AVE STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3225
Country	:	US
Telephone Number	:	773-770-4824
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/22/2024

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