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General NPI Number Information
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NPI Number | 1205989605
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Entity Type | Individual
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Provider Name | MARK DANIEL CLARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 3735 NORTON HILLS RD
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City | NORTON SHORES
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State | MI
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Zip | 49441-4469
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Country | US
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Telephone | 231-780-0484
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Fax |
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Provider Business Mailing Address
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Address Line | 3735 NORTON HILLS RD
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City | NORTON SHORES
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State | MI
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Zip | 49441-4469
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Country | US
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Telephone | 231-780-0484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 4301055514
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301055514
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 4301055514
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 4301055514
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License Number State | MI
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