MEDICARE: WILLIAM D CLARK MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	4301068667	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922096718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM D CLARK MD

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18101 OAKWOOD BLVD STE 124
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-4089
Country	:	US
Telephone Number	:	313-586-5011
Fax Number	:	313-592-7134

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	02/20/2024

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Directions to “ WILLIAM D CLARK MD” Practice Location

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