Individual
TODD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL DOCTOR
Contact information
Practice address
1775 W DEMPSTER ST, 1 WEST, PARK RIDGE, IL 60068-1143
(847) 723-5150
(847) 723-2083
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1143
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-107180
IL
207P00000X
Emergency Medicine Physician
A84896
CA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036-107180
IL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
A84896
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A84896
—
CA
05
—
00A848960
—
CA
Enumeration date
11/02/2005
Last updated
09/19/2022
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