Individual
MR. EVAN JACOB CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13250 WASHINGTON AVE, MOUNT PLEASANT, WI 53177-1516
(262) 799-8200
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2021019559
MO
207P00000X
Emergency Medicine Physician
Primary
71908-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100093430
—
WI
Enumeration date
04/26/2018
Last updated
04/06/2026
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