Individual
STEVEN M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 E COUNTY LINE ROAD, SUITE 201, GREENWOOD, IN 46143
(317) 865-8000
(317) 865-8012
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01052195A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000014025
MDWISE/PROHEALTH
IN
01
—
000000091132
ANTHEM BLUE CROSS
IN
01
—
020047583
MEDICARE RAILROAD
IN
01
—
10781002
CAQH ID
—
05
—
200281580A
—
IN
01
—
5263695
AETNA ELIGIBILITY ID
IN
01
—
P01456868
MEDICARE RR
IN
Enumeration date
07/04/2006
Last updated
11/27/2023
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