MEDICARE: DR. KIRK 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	207Y00000X	Otolaryngology Physician	036-111954	IL

General Provider Information

NPI Number	:	1750387270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK R CLARK M.D.

Provider Business Mailing Address
First Line	:	5999 NEW WILKE RD BLDG 1
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-4506
Country	:	US
Telephone Number	:	847-259-2530
Fax Number	:	847-259-4930

Provider Business Practice Location Address
First Line	:	5999 NEW WILKE RD BLDG 1
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-4506
Country	:	US
Telephone Number	:	847-259-2530
Fax Number	:	847-259-4930

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/17/2022

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