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NPI Code Detail

MEDICARE: ELIZABETH CLARK MD

MEDICARE:   ELIZABETH  CLARK  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1023713963
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CLARK MD
Provider Business Mailing Address
First Line : 8414 NAAB RD STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1972
Country : US
Telephone Number : 317-338-7510
Fax Number : 317-338-7541
Provider Business Practice Location Address
First Line : 8414 NAAB RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1972
Country : US
Telephone Number : 317-338-7510
Fax Number : 317-338-7541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2023
Last Update Date : 04/06/2026

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