MEDICARE: SHAUN M CLARKE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601004561	MI

General Provider Information

NPI Number	:	1639187230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN M CLARKE PA-C

Provider Business Mailing Address
First Line	:	4000 WELLNESS DR
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48670-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 E HOUGHTON AVE
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-1127
Country	:	US
Telephone Number	:	989-345-8130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	12/19/2024

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