Individual
MICHAEL STEVEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-5000
Mailing address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-5000
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
59352
MN
2085R0202X
Diagnostic Radiology Physician
Primary
59352
MN
Other
Enumeration date
06/03/2014
Last updated
06/18/2020
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