Clark, Terry L

Clark, Terry L is an individual health care provider with primary practice located at 728 Pennsylvania Ave , Sheboygan WI 53081-4669. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Clark, Terry L can be contacted via phone (920) 803-8014.

Contact Information

Primary practice address
728 Pennsylvania Ave Sheboygan WI 53081-4669
Phone: (920) 803-8014
Fax: (920) 803-8015
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 649-025 Wisconsin
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 105334-0501 Utah

Profile Details

NPI number 1326008277
LBN Legal business name Clark, Terry L
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 24th, 2006
Last updated Jul 9th, 2007 - about 17 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 1326008277 NPPES
Wisconsin MEDICAID 43213700

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