Individual
CLARK A COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1504 MADISON AVE, FORT ATKINSON, WI 53538-3100
(920) 563-7888
(920) 563-7741
Mailing address
PO BOX 249, FORT ATKINSON, WI 53538-0249
(920) 568-5411
(920) 568-4004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1029-023
WI
363AM0700X
Medical Physician Assistant
Primary
1029-023
WI
363AS0400X
Surgical Physician Assistant
1029-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42974300
—
WI
01
—
60272
DEAN HEALTH INSURANCE
WI
Enumeration date
05/01/2006
Last updated
06/21/2018
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