Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301093174 | MI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME98114 | FL |
NPI | 1730303470 |
---|---|
Provider Name | Dr. Michael Sylvester Clarke |
First Address | Kalamazoo, MI 49007-2557 |
Second Address | Kalamazoo, MI 49007-2557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0803913791 | BCBS (01) | MI |