Individual
PROF. BRUCE M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.P.O
Contact information
Practice address
24395 GREENFIELD RD, SOUTHFIELD, MI 48075-3118
(248) 557-2323
(248) 557-3639
Mailing address
24395 GREENFIELD ROAD, SOUTHFIELD, MI 48075
(248) 557-2323
(248) 557-3639
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
921
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05096363
—
MI
Enumeration date
09/06/2006
Last updated
07/09/2007
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