Individual
KYLE R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5666 E STATE ST, ROCKFORD, IL 61108-2425
(815) 226-2000
Mailing address
1395 JAY ST, FREEPORT, IL 61032-8424
(815) 291-4052
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007488
IL
Other
Enumeration date
04/10/2020
Last updated
04/10/2020
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