Individual
DR. MICHAEL W CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 983-8300
Mailing address
18828 N FRUITPORT RD, SPRING LAKE, MI 49456-1160
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
008264
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2580269
—
MI
05
—
4742455
—
MI
05
—
4742464
—
MI
01
—
MC008264
BC/BS
MI
Enumeration date
06/23/2006
Last updated
01/28/2011
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