Individual
CLEMON PARDALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2775 BLAKE RD, JACKSON, MI 49201-8838
(517) 787-2906
(517) 787-3039
Mailing address
PO BOX 609, UNION LAKE, MI 48387-0609
(248) 366-9504
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5101005389
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7891257
AETNA
MI
Enumeration date
03/07/2007
Last updated
07/08/2007
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