Individual
DR. CLARK BART DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
29201 TELEGRAPH RD, SUITE 500, SOUTHFIELD, MI 48034-1331
(248) 569-5985
(248) 569-3704
Mailing address
29201 TELEGRAPH RD, SUITE 500, SOUTHFIELD, MI 48034-1331
(248) 569-5985
(248) 569-3704
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
CD046491
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3211330
—
MI
Enumeration date
12/23/2005
Last updated
03/13/2012
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