MEDICARE: DR. DESIREE A CLARKE 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
1	202K00000X	Phlebology Physician	ME151858	FL
2	207V00000X	Obstetrics & Gynecology Physician	ME151858	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568423168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESIREE A CLARKE MD

Provider Business Mailing Address
First Line	:	3820 NORTHDALE BLVD STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1893
Country	:	US
Telephone Number	:	630-725-2730
Fax Number	:	844-205-5691

Provider Business Practice Location Address
First Line	:	2290 10TH AVE N STE 101
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6609
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/24/2025

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