DR. KIRBY P CLARK (NPI# 1407893795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1407893795 |
Entity Type | Individual |
Full Name | DR. KIRBY P CLARK |
Credential | M.D. |
Practice Address |
660 N Westmoreland Rd Lake Forest IL 60045-1659 |
Mailing Address |
1275 E Belvidere Rd Ste 200 Grayslake IL 60030-2083 |
Practice Telephone | 8475357480 |
Mailing Telephone | 8475357480 |
Mailing Fax Number | 8479684311 |
Enumeration Date | 2006-06-02 |
Last Update Date | 2018-01-10 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
036126457 | IL | Allopathic & Osteopathic Physicians |
N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
42049-20 | WI | Allopathic & Osteopathic Physicians |
N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
35956 | IA | Allopathic & Osteopathic Physicians |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1447288311 | Kirby Dwight Clark | Family Medicine | Ufp Phalen Village Clinic, 1414 Maryland Avenue East, Saint Paul, MN 55106 | 2006-06-29 |
Street Address |
660 N WESTMORELAND RD |
City | LAKE FOREST |
State | IL |
Zip Code | 60045-1659 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588661318 | Regis J Weiss | Obstetrics & Gynecology | 660 N Westmoreland Rd, Suite 306, Lake Forest, IL 60045-1659 | 2005-07-07 |
1508377532 | Meghan Strand | Physician Assistant | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2017-10-17 |
1538689864 | Amanda D Froeming | Physician Assistant | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2017-06-27 |
1639608409 | Kristin Rae Elinski | Physician Assistant | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2017-06-06 |
1386173235 | Erika L Tait | Physician Assistant | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2017-06-05 |
1437685252 | Melissa Kathryn Demiglio | Physician Assistant | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2017-05-11 |
1891231312 | Jill Alden | Clinical Nurse Specialist | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2017-01-07 |
1588108203 | Sarah Latoria | Nurse Practitioner | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2016-12-14 |
1184172488 | Ken Dizon | Registered Nurse | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2016-09-14 |
1194182949 | Meagan Reitz | Physician Assistant | 660 N Westmoreland Rd, Lake Forest, IL 60045-1659 | 2016-01-25 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1851931109 | Spine & Wellness Clinic, Inc. | Chiropractor | 775 N Bank Lane Suite 101, Lake Forest, IL 60045 | 2020-01-14 |
1184278640 | Mary Belluomini Dipietro | Dietitian, Registered | 1000 North Westmoreland Rd., Lake Forest, IL 60045 | 2019-08-01 |
1336621747 | Brook Elizabeth Orvis | Physical Therapist | 1000 N Westmoreland Road, 2nd Floor, Pavilion B, Lake Forest, IL 60045 | 2018-08-31 |
1336621028 | Michelle Nebel | Audiologist | 225 East Deerpath, Suite 223, Lake Forest, IL 60045 | 2018-08-30 |
1467951731 | Devan Keesling | Audiologist | 800 N Westmoreland Rd Ste Ll30, Lake Forest, IL 60045 | 2018-02-01 |
1023516796 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1000 N Westmoreland Rd Ste A, Lake Forest, IL 60045 | 2018-01-29 |
1275056780 | Karen Elizabeth Cohen | Counselor | 1331 S. Estate Lane, Lake Forest, IL 60045 | 2017-07-18 |
1497281711 | Caroline Connors | Speech-Language Pathologist | 660 Westmoreland Road, Lake Forest, IL 60045 | 2017-05-05 |
1013453406 | Katie L Konopacz | Nurse Practitioner | 1000 N Westmoreland Rd # B, Lake Forest, IL 60045 | 2017-01-10 |
1225424575 | Sean Robert Wessel | Internal Medicine | 1000 N Westmoreland Rd Ste 3556, Lake Forest, IL 60045 | 2015-04-14 |
Find all providers in zip 60045 |
Taxonomy Code | 2085R0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Radiology |
Specialization | Diagnostic Radiology |
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548457955 | Roee Lazebnik | Radiology | 275 N Field Dr, Lake Forest, IL 60045-2579 | 2007-09-29 |
1194741389 | Dana A Gray | Radiology | 660 N Westmoreland Rd Dept Of, Lake Forest, IL 60045-1659 | 2006-07-14 |
1194724542 | Unique Medical Imaging Sc | Radiology | 840 S Waukegan Rd, Suite 214, Lake Forest, IL 60045-2608 | 2005-07-19 |
1083103006 | Reza Dehdari Md Inc | Radiology | 22972 El Toro Rd, Lake Forest, CA 92630-4961 | 2018-05-04 |
1972846236 | Lioubov Soulii | Radiology | 1000 N Westmoreland Rd, Lake Forest, IL 60045-1658 | 2013-04-04 |
1184987356 | Saudur Rahman | Radiology | 1000 N Westmoreland Rd, Lake Forest, IL 60045-1658 | 2012-06-21 |
1063778462 | Ramanujam Govindarajan Prativadi | Radiology | 1000 N Westmoreland Rd, Radiology Department, Lake Forest, IL 60045-1658 | 2012-04-10 |
1205102019 | Firas Ramahi | Radiology | 1000 N Westmoreland Rd, Lake Forest, IL 60045 | 2012-03-26 |
1215101712 | Steven C Sauk | Radiology | 1000 N Westmoreland Rd, Lake Forest, IL 60045 | 2008-04-15 |
1467656041 | Deepa Nonesupplied Popuri | Radiology | 1000 N Westmoreland Rd, Lake Forest, IL 60045-1658 | 2007-06-14 |
Find all providers in LAKE FOREST |
City | LAKE FOREST |
Zip Code | 60045 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.