Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1957 | TX |
N | 222Z00000X | Podiatrist | 1957 | TX |
N | 213E00000X | Podiatrist | 2011018233 | MO |
N | 222Z00000X | Podiatrist | 2011018233 | MO |
Y | 213EP1101X | Primary Podiatric Medicine | 016-005209 | IL |
NPI | 1295780153 |
---|---|
Provider Name | Dr. Michelle Renee Murray-Clark |
First Address | Northbrook, IL 60065-0917 |
Second Address | Northbrook, IL 60062-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 22/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016005209 | (05) | IL |
0732240001 | DMERC # WITH PPG (01) | |
1295780153 | (05) | MO |
320181601 | (05) | TX |
320181602 | (05) | TX |
320181603 | (05) | TX |
U82239 | (02) |