Individual
DR. STEVEN G CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2351 BROADWAY ST, PEKIN, IL 61554-3972
(309) 353-4159
(309) 353-4531
Mailing address
2351 BROADWAY ST, PEKIN, IL 61554-3972
(309) 353-4159
(309) 353-4531
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036049330
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036049330
—
IL
01
—
09015685
BLUE CROSS BLUE SHIELD
IL
01
—
P00355237
RAIL ROAD MEDICARE
IL
Enumeration date
05/22/2006
Last updated
11/26/2014
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