NPI 1003475880

Ralph Clark

Practitioner Driver Harvey, IL

Practice location

Address: 14847 Vail Ave, Harvey, IL 60426-1536
Phone: (773) 724-9433
Mailing address: 12003 S Pulaski Rd APT 256, Alsip, IL 60803-1221

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence C46272064039 (IL)

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Registry record

NPI: 1003475880
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Jun 2019
Record last updated: 6 Jun 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.