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General NPI Number Information
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NPI Number | 1982086492
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Entity Type | Individual
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Provider Name | SAMANTHA ANNE CLARK D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1215 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912
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Country | US
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Telephone | 207-205-7674
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 E MICHIGAN AVE
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City | LANSING
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State | MI
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Zip | 48912-1896
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Country | US
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Telephone | 207-205-7674
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 18840
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5101022012
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License Number State | MI
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