Individual
DR. KASANDRIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1555 W HOWARD ST, CHICAGO, IL 60626-1707
(773) 764-7146
Mailing address
4104 N WESTERN AVE APT 3N, CHICAGO, IL 60618-2848
(618) 558-4233
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036172412
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2022
Last updated
06/09/2025
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