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General NPI Number Information
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NPI Number | 1457670184
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Entity Type | Individual
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Provider Name | STEPHANIE MICHELE CLARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 375 BRIARWOOD CIRCLE BUILDING 3
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City | ANN ARBOR
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State | MI
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Zip | 48108-1605
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Country | US
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Telephone | 734-998-7207
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Fax | 734-998-7100
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Provider Business Mailing Address
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Address Line | 3621 SOUTH STATE STREET 700 KMS PLACE
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 734-936-2047
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301102116
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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