Clark, Ian

Clark, Ian is an individual health care provider with primary practice located at 2650 Ridge Ave , Evanston IL 60201-1700. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Clark, Ian can be contacted via phone (847) 570-2132.

Contact Information

Primary practice address
2650 Ridge Ave Evanston IL 60201-1700
Phone: (847) 570-2132
Fax: (847) 570-2927
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 036161858 Illinois
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 56522 Tennessee

Profile Details

NPI number 1669985958
LBN Legal business name Clark, Ian
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2017
Last updated Sep 2nd, 2026 - about last month

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669985958 NPPES
Tennessee MEDICAID Q033048

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