Organization
DANIEL L CLARK DO LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL LEE CLARK DO (PRESIDENT)
(815) 838-0052
Entity
Organization
Contact information
Practice address
14831 W 159TH ST, HARRIS BANK BUILDING, LOCKPORT, IL 60491
(815) 838-0052
(815) 838-4410
Mailing address
14831 W 159TH ST, HARRIS BANK BUILDING, LOCKPORT, IL 60491
(815) 838-0052
(815) 838-4410
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036071157
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0991512865
BCBS
—
Enumeration date
11/02/2006
Last updated
08/22/2020
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