Edith Clark DPM PLLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

EC001742 Issued in MI

Legal business name

EDITH CLARK DPM PLLC

Practice address

125 Dwyer St
Clare, MI 48617-1002

Phone

(989) 386-9721

NPI assigned

Dec 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edith Clark, DPMNPI 1770559528

Title

Physician

Phone

(989) 386-9721

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edith Clark, DPM

  • Podiatrist
  • Clare, MI
  • NPI 1770559528
  Medicare reassignment Care Compare group NPD Authorized official
• David C Vance, DPM

  • Podiatrist
  • Grand Blanc, MI
  • NPI 1043703176
  Medicare reassignment Care Compare group NPD
• Ryan Anthony Marks, DPM

  • Foot & Ankle Surgery Podiatrist
  • Parma, OH
  • NPI 1639606239

  MI

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1023174273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 LEONARD ST NW",
            "address_2": "SUITE 103",
            "city": "WALKER",
            "state": "MI",
            "postal_code": "495348447",
            "telephone_number": "616-453-6329",
            "fax_number": "616-453-1725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 DWYER ST",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486171002",
            "telephone_number": "989-386-9721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDITH CLARK DPM PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDITH",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "989-386-9721",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "EC001742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4613888",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marc Alexander Dean, CRNA
• Elaine Helen Demasi, LMSW
• Madyson Lousie Deroo
• Kayla Marie Dinnan
• Darlene M. Donaldson, P.T.A.
• Lindsey Elias
• Madeleine K Elwell, RD
• Kimberly Emmer
• Gregory J Endresbercher, MD
• Evergreen Physical Therapy Limited Partnership

• Podiatrist in Clare, MI
• Providers in Clare, MI by specialty
• Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.