Organization
CLARK CENTER FOR COMPREHENSIVE MEDICINE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD GODFREY CLARK (OWNER)
(734) 367-1205
Entity
Organization
Contact information
Practice address
29521 FORD RD, GARDEN CITY, MI 48135
(734) 367-1205
(734) 367-1214
Mailing address
29521 FORD RD, GARDEN CITY, MI 48135-2319
(734) 367-1205
(734) 367-1214
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110H221360
BLUE CROSS BLUE SHIELD
—
01
—
DB2730
MEDICARE RAIL ROAD
—
Enumeration date
03/05/2007
Last updated
03/15/2019
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