Individual
GLEN T CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
468 CADIEUX RD, GROSSE POINTE, MI 48230-1507
(313) 473-1000
(313) 473-1934
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301051119
MI
Other
Enumeration date
08/10/2006
Last updated
07/19/2022
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