Individual
DEBORAH KEM CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11725 N ILLINOIS ST, STE 465, CARMEL, IN 46032-3008
(317) 817-0010
(317) 817-0012
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01064614A
IN
207R00000X
Internal Medicine Physician
R1460
KY
208M00000X
Hospitalist Physician
01064614A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000668456
ANTHEM PTAN
IN
05
—
200978720
—
IN
Enumeration date
02/22/2007
Last updated
03/05/2025
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