Clark, Diana L

Clark, Diana L is an individual health care provider with primary practice located at 701 E County Line Rd Ste 301 , Greenwood IN 46143-1071. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Clark, Diana L can be contacted via phone (317) 883-4736.

Contact Information

Primary practice address
701 E County Line Rd Ste 301 Greenwood IN 46143-1071
Phone: (317) 883-4736
Fax: (317) 859-1576
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01029421A Indiana

Profile Details

NPI number 1225039860
LBN Legal business name Clark, Diana L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 4th, 2005
Last updated Jul 2nd, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225039860 NPPES
Indiana MEDICAID 200224710

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