Individual
KELLIE MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
490 EDWARD ST, MIDDLEVILLE, MI 49333-9131
(269) 795-4434
(269) 795-4271
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301511876
MI
Other
Enumeration date
07/17/2020
Last updated
09/11/2024
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