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Individual

ALYSA MICHELLE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
100 MICHIGAN ST NE # MC049, GRAND RAPIDS, MI 49503-2560
(616) 391-1680
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
(616) 975-1845

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4351045601
MI
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
4301504949
MI

Other

Enumeration date
06/29/2019
Last updated
04/09/2024
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