Individual
KENNETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2025 E NEWPORT AVE, MILWAUKEE, WI 53211-2906
(414) 961-3841
Mailing address
500 W BROWN DEER RD, SUITE 202, BAYSIDE, WI 53217-1627
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22673
WI
Other
Enumeration date
12/01/2005
Last updated
08/13/2007
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