Healthcare Provider Details

I. General information

NPI: 1497983142
Provider Name (Legal Business Name): MICHAEL CLARKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MT HIGHWAY 91 S
DILLON MT
59725-7379
US

IV. Provider business mailing address

212 SCHULTZ LN
DILLON MT
59725-8272
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-9221
  • Fax:
Mailing address:
  • Phone: 406-925-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: