Provider Demographics
NPI:1689917452
Name:CLARY-SELLI, TYRISHA (MD)
Entity type:Individual
Prefix:
First Name:TYRISHA
Middle Name:
Last Name:CLARY-SELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TYRISHA
Other - Middle Name:
Other - Last Name:CLARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1357 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2392
Practice Address - Country:US
Practice Address - Phone:773-881-7258
Practice Address - Fax:773-881-7234
Is Sole Proprietor?:No
Enumeration Date:2013-03-31
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-139007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine