Individual
NATHANIEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
409 W OAK ST, CARBONDALE, IL 62901-1464
(618) 529-4455
(618) 351-1287
Mailing address
409 W OAK ST, CARBONDALE, IL 62901-1464
(618) 529-4555
(618) 351-1287
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
085-003278
IL
363A00000X
Physician Assistant
Primary
085003278
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00657126
RAILROAD MEDICARE
IL
Enumeration date
09/03/2008
Last updated
12/21/2022
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