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NPI Code Detail

MEDICARE: CLARK A. ELLIOTT M.D.

MEDICARE: CLARK A. ELLIOTT M.D.
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
1207Y00000XOtolaryngology Physician41717KY
2207YP0228XPediatric Otolaryngology Physician41717KY
3207Y00000XOtolaryngology Physician12266ND

General Provider Information

NPI Number : 1871540567
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARK A. ELLIOTT M.D.
Provider Business Mailing Address
First Line : 1104 CASS ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-3236
Country : US
Telephone Number : 231-941-1155
Fax Number : 231-259-1005
Provider Business Practice Location Address
First Line : 1104 CASS ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-3236
Country : US
Telephone Number : 231-941-1155
Fax Number : 231-259-1005
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 01/16/2025

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Directions to “ CLARK A. ELLIOTT M.D.” Practice Location

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