Individual
DR. JOHN ROBERT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
370 E CHICAGO ST STE 400, COLDWATER, MI 49036-2062
(517) 279-8465
(517) 279-8665
Mailing address
274 E CHICAGO ST, COLDWATER, MI 49036-2041
(517) 279-8465
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01044745A
IN
207V00000X
Obstetrics & Gynecology Physician
6766
ND
207V00000X
Obstetrics & Gynecology Physician
Primary
JC062758
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-30237
IBA/PHP
MI
01
—
1607527581
BLUE CROSS BLUE SHIELD
MI
05
—
3044976
—
MI
01
—
P89384
BLUE CARE NETWORK
MI
Enumeration date
08/10/2005
Last updated
08/12/2024
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