Sue Clark, MD | |
507 E Armstrong Ave, Regional Development Center, Peoria, IL 61603-3201 | |
(309) 681-6960 | |
Not Available |
Full Name | Sue Clark |
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Gender | Female |
Speciality | Pediatrics - Developmental - Behavioral Pediatrics |
Location | 507 E Armstrong Ave, Peoria, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1174597371 | NPI | - | NPPES |
07215036 | Other | IL | BCBS |
IL01Z4 | Other | IL | JOHN DEERE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2080P0006X | Pediatrics - Developmental - Behavioral Pediatrics | (Illinois) | Primary |
Entity Name | The Board Of Trustees Of The University Of Illinois |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1386863819 PECOS PAC ID: 3072422716 Enrollment ID: O20031112000158 |
Mailing Address | Practice Location Address |
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Sue Clark, MD 1 Illini Dr, Peoria, IL 61605-2576 Ph: (309) 671-8503 | Sue Clark, MD 507 E Armstrong Ave, Regional Development Center, Peoria, IL 61603-3201 Ph: (309) 681-6960 |
Thomas James Mcmorrow, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2553 Fax: 309-655-2602 | |
Jessica Ford-davis, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2274 | |
Kelsey Elizabeth Grimes, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Jessica N Mistretta, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Mrs. Valeria Claudia Benavides Lopez, M.D., M.P.H. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-3313 | |
Khalid Al Katranji, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7171 | |
Dr. Gretchen L Kopec, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-0615 |