Individual
DR. MARK A. CLEMENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6080 S 108TH ST, HALES CORNERS, WI 53130-2557
(414) 425-5351
(414) 529-6350
Mailing address
PO BOX 689711, MILWAUKEE, WI 53268-9711
(414) 456-3100
(414) 456-3113
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34043
WI
207RI0200X
Infectious Disease Physician
34043
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045668480
MEDICARE PTAN
WI
01
—
049873840
MEDICARE PTAN
WI
05
—
32081200
—
WI
Enumeration date
08/25/2005
Last updated
11/17/2008
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