Individual
DR. STEVEN G CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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