Healthcare Provider Details

I. General information

NPI: 1013970656
Provider Name (Legal Business Name): MICHAEL CLEMENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 E BASELINE RD
PHOENIX AZ
85042-6551
US

IV. Provider business mailing address

2702 N 3RD ST
PHOENIX AZ
85004-4608
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 602-243-1235
Mailing address:
  • Phone: 602-323-3407
  • Fax: 602-323-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: