Individual
DR. JACK D CLEMIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
151 N MICHIGAN AVE, #914, CHICAGO, IL 60601-7506
(312) 938-4327
(312) 938-0490
Mailing address
151 N MICHIGAN AVE, #914, CHICAGO, IL 60601-7506
(312) 938-4327
(312) 938-0490
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
036-038421
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1604366
BLUE CROSS
IL
Enumeration date
08/18/2005
Last updated
02/13/2013
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