MEDICARE: JACK D. CLEMIS, MD SC

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	174400000X	Specialist	036038421	IL

General Provider Information

NPI Number	:	1851434658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK D. CLEMIS, MD SC

Provider Business Mailing Address
First Line	:	151 N MICHIGAN AVE
Second Line	:	SUITE 914
City	:	CHICAGO
State	:	IL
Zip	:	60601-7506
Country	:	US
Telephone Number	:	312-938-4327
Fax Number	:	312-938-0490

Provider Business Practice Location Address
First Line	:	151 N MICHIGAN AVE
Second Line	:	SUITE 914
City	:	CHICAGO
State	:	IL
Zip	:	60601-7506
Country	:	US
Telephone Number	:	312-938-4327
Fax Number	:	312-938-0490

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JACK D CLEMIS
Credential	:	MD
Telephone Number	:	312-938-4327

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	02/07/2013

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