| Daniel L Clark Do Ltd | |
|
14831 W 159th St Harris Bank Building Lockport IL 60491 | |
| (815) 838-0052 | |
| (815) 838-4410 |
| Full Name | Daniel L Clark Do Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 14831 W 159th St, Lockport, Illinois |
| Authorized Official Name and Position | Daniel Lee Clark (PRESIDENT) |
| Authorized Official Contact | 8158380052 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Daniel L Clark Do Ltd 14831 W 159th St Harris Bank Building Lockport IL 60491 Ph: (815) 838-0052 | Daniel L Clark Do Ltd 14831 W 159th St Harris Bank Building Lockport IL 60491 Ph: (815) 838-0052 |
| NPI Number | 1093893117 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093893117 | NPI | - | NPPES |
| 0991512865 | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036071157 (Illinois) | Primary |
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