Provider Demographics
NPI:1366485831
Name:CLARKE, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:CLARKE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:#1532
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-7234
Mailing Address - Fax:312-864-9725
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:#1532
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-7234
Practice Address - Fax:312-864-9725
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-074696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG76111Medicare UPIN