Individual
DR. JACOB A CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(949) 750-4751
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(949) 545-8468
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1922757541
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
03/21/2022
Last updated
06/02/2022
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