Individual
REBECCA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
660 BEAVER CREEK CIR, SUITE 100, MAUMEE, OH 43537-1745
(419) 891-6221
(419) 893-3394
Mailing address
660 BEAVER CREEK CIR, SUITE 100, MAUMEE, OH 43537-1745
(419) 891-6221
(419) 893-3394
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35080735
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000246226
ANTHEM
OH
01
—
04219
PARAMOUNT
OH
01
—
12-04381
UHC
OH
05
—
2333264
—
OH
01
—
7534411
AETNA
OH
Enumeration date
08/12/2005
Last updated
11/03/2023
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