Individual
MICHAEL L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
596 W MAIN ST, WILMINGTON, OH 45177-2123
(937) 283-2588
(937) 283-2594
Mailing address
610 W MAIN ST, WILMINGTON, OH 45177-2125
(937) 283-9815
(937) 283-9839
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35062520C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0969420
—
OH
Enumeration date
03/28/2006
Last updated
11/12/2024
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