Individual
DR. MICHAEL ROBERT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
3400 MINISTRY PKWY, SCHOFIELD, WI 54476-5220
(715) 393-3723
Mailing address
3400 MINISTRY PKWY, SCHOFIELD, WI 54476-5220
(715) 393-3723
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
50630
WI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
50630
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100004191
—
WI
01
—
360450063
MEDICARE
—
Enumeration date
07/11/2007
Last updated
08/18/2015
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