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General NPI Number Information
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NPI Number | 1285664052
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Entity Type | Individual
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Provider Name | STEVEN M CLARK MD
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 701 E COUNTY LINE ROAD SUITE 201
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City | GREENWOOD
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State | IN
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Zip | 46143
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Country | US
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Telephone | 317-865-8000
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Fax | 317-865-8012
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST SUITE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2805
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01052195A
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License Number State | IN
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