Individual
DR. MARK CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7477 S STATE RD, GOODRICH, MI 48438-8745
(810) 636-2235
(810) 636-3008
Mailing address
7477 S STATE RD, GOODRICH, MI 48438-8745
(810) 636-2235
(810) 636-3008
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301044876
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3236035
—
MI
Enumeration date
09/02/2006
Last updated
11/21/2011
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