Clark, John Robert

Clark, John Robert is an sole proprietor health care provider with primary practice located at 600 S Lakeview St Suite 207, Sturgis MI 49091-2371. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Clark, John Robert can be contacted via phone (269) 659-4646.

Contact Information

Primary practice address
600 S Lakeview St Suite 207 Sturgis MI 49091-2371
Phone: (269) 659-4646
Fax: (269) 651-2210
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X JC062758 Michigan
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 01044745A Indiana
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 6766 North Dakota

Profile Details

NPI number 1457353575
LBN Legal business name Clark, John Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 10th, 2005
Last updated Jul 12th, 2010 - about 14 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 1457353575 NPPES
Michigan Other 07-30237 IBA/PHP
Michigan Other P89384 IBA/PHP
Michigan Other 1607527581 IBA/PHP
Michigan MEDICAID 3044976 IBA/PHP

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