Provider Demographics
NPI:1255427779
Name:CLEMENTS, DEBORAH S (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:S
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 N LAKE SHORE DR
Mailing Address - Street 2:ABBOTT HALL, 4TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3006
Mailing Address - Country:US
Mailing Address - Phone:312-503-1275
Mailing Address - Fax:
Practice Address - Street 1:1275 E BELVIDERE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2082
Practice Address - Country:US
Practice Address - Phone:847-926-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200003340BMedicaid
MO26402044OtherBCBS KANSAS CITY
KS373060OtherFIRSTGUARD
MO209401900Medicaid
G66344Medicare UPIN
KS200003340BMedicaid