Individual
STACIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6700 N ROCHESTER RD STE 112, ROCHESTER HILLS, MI 48306-4378
(248) 650-1510
Mailing address
6700 N ROCHESTER RD STE 112, ROCHESTER HILLS, MI 48306-4378
(248) 650-1510
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301117007
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2015
Last updated
01/05/2020
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