Individual
ANDREA SUE CLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5404 W ELM ST, SUITE Q, MCHENRY, IL 60050-4052
(815) 344-0020
(815) 344-0076
Mailing address
5404 W ELM ST, SUITE Q, MCHENRY, IL 60050-4052
(815) 344-0020
(815) 344-0076
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036123085
IL
207Q00000X
Family Medicine Physician
34007131C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000201819
ANTHEM
—
05
—
2184372
—
OH
Enumeration date
05/03/2006
Last updated
07/25/2010
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