Michael L. Clark, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

35040176 Issued in OH

Practice address

715 S Taft Ave
Fremont, OH 43420-3200

Phone

(419) 334-6624

Fax

(419) 334-6602

NPI assigned

Jun 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastriver Anesthesia Services, Inc.

  • Anesthesiology Physician
  • Oregon, OH
  • NPI 1962574160
  NPD (past)
• Memorial Anesthesia, LTD.

  • Anesthesiology Physician
  • Fremont, OH
  • NPI 1801929898
  NPD (past)
• Southwest Anesthesia Services, PSC, Inc.

  • Anesthesiology Physician
  • Maumee, OH
  • NPI 1235188129
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376579482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2007 SCOTTWOOD AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436201638",
            "telephone_number": "419-334-6624",
            "fax_number": "419-334-6602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 S TAFT AVE",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203200",
            "telephone_number": "419-334-6624",
            "fax_number": "419-334-6602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "35040176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0324929",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sally Chevalier, DVM
• Jacquelyn Chorba
• Stephanie Churella
• Clara Jackson Schermerhorn, MD, PHD, LLC
• Clara Psychiatry, LLC
• Jessica W Clarke, D.P.M.
• John Joseph Clarke, DPM
• Laura Miranda Clarke
• Karen Clemons
• Connie Close

• Anesthesiology Physician in Fremont, OH
• Providers in Fremont, OH by specialty
• Anesthesiology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.