MEDICARE: MR. JOHN 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	208600000X	Surgery Physician	125070699	IL
2	2085R0202X	Diagnostic Radiology Physician	35.144215	OH

General Provider Information

NPI Number	:	1689888422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CLARKE MD

Provider Business Mailing Address
First Line	:	8012 GLENDEVAN ST NW
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44646-9017
Country	:	US
Telephone Number	:	504-717-9733
Fax Number	:

Provider Business Practice Location Address
First Line	:	8012 GLENDEVAN ST NW
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44646-9017
Country	:	US
Telephone Number	:	504-717-9733
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	05/17/2022

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Directions to “ MR. JOHN CLARKE MD” Practice Location

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