Individual
JOE CLINKENBEARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2421 LAPORTE AVE, VALPARAISO, IN 46383-6914
(219) 462-6192
(219) 464-2585
Mailing address
1040 SIERRA DR, SUITE 400, GREENWOOD, IN 46143-7241
(317) 528-4252
(317) 865-8318
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000235
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000721671
ANTHEM TRADITIONAL
IN
Enumeration date
07/01/2005
Last updated
05/16/2012
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