Individual
BETHANY ANN CLUSKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
676 N SAINT CLAIR ST, STE 1880, CHICAGO, IL 60611-3139
(312) 642-9844
(312) 642-7637
Mailing address
676 N SAINT CLAIR ST, STE 1880, CHICAGO, IL 60611-3139
(312) 642-9844
(312) 642-7637
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
336105834
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151020338
MEDICARE PTAN
IN
Enumeration date
04/13/2011
Last updated
06/13/2019
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