Individual
NATASHA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
24 JOLIET ST, DYER, IN 46311-1705
(317) 322-5747
(219) 864-2282
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01079918A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300017254
—
IN
Enumeration date
05/13/2014
Last updated
04/17/2023
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