Individual
ANDREW BURNHAM CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
609 FORD ST, MAUMEE, OH 43537-1947
(419) 893-5539
(419) 893-6853
Mailing address
609 FORD ST, MAUMEE, OH 43537-1947
(419) 893-5539
(419) 893-6853
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36.002902
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000135414
ANTHEM
—
01
—
02222
PARAMOUNT
OH
05
—
0321182
—
OH
Enumeration date
07/20/2005
Last updated
02/12/2010
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