Individual
DR. KATHY S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5901 TECHNOLOGY CENTER DR, INDIANAPOLIS, IN 46278-6013
(317) 328-5050
(317) 715-9965
Mailing address
5901 TECHNOLOGY CENTER DR, INDIANAPOLIS, IN 46278-6013
(317) 328-5050
(317) 328-5053
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01036050A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000214716
ANTHEM-351158723
IN
01
—
000000492338
ANTHEM 203778927
IN
01
—
011838
SIHO-351158723
IN
01
—
085331
HEALTH ALLIANCE-351158723
IN
05
—
100348870
—
IN
01
—
300128808
RR MEDICARE-351158723
IN
01
—
Q0085630
CMOSHO351158723-352047427
IN
Enumeration date
05/24/2005
Last updated
10/03/2016
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