Individual
CLARENCE A PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1645 W JACKSON BLVD, SUITE 215, CHICAGO, IL 60612-3276
(312) 942-6800
(312) 942-3551
Mailing address
1645 W JACKSON BLVD, SUITE 215, CHICAGO, IL 60612-3276
(312) 942-6800
(312) 942-3551
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036105357
IL
208000000X
Pediatrics Physician
Primary
036-105357
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105351
—
IL
Enumeration date
02/08/2006
Last updated
06/03/2009
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