Clemence, Mark A.

Clemence, Mark A. is an individual health care provider with primary practice located at 6080 S 108Th St , Hales Corners WI 53130-2557. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Infectious Disease. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Clemence, Mark A. can be contacted via phone (414) 425-5351.

Contact Information

Primary practice address
6080 S 108Th St Hales Corners WI 53130-2557
Phone: (414) 425-5351
Fax: (414) 529-6350
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 34043 Wisconsin
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X 34043 Wisconsin

Profile Details

NPI number 1255324216
LBN Legal business name Clemence, Mark A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 25th, 2005
Last updated Nov 17th, 2008 - 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 1255324216 NPPES
Wisconsin Other 045668480 MEDICARE PTAN
Wisconsin Other 049873840 MEDICARE PTAN
Wisconsin MEDICAID 32081200 MEDICARE PTAN

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