Megan N Clark, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301065618 Issued in MI

Practice address

710 Kenmoor Ave SE
Suite 110
Grand Rapids, MI 49546-2379

Phone

(616) 949-6112

Fax

(616) 949-8530

NPI assigned

Sep 24, 2006

Sex

Female

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.

• Western Michigan Pediatrics, PC

  • Pediatrics Physician
  • Grand Rapids, MI
  • NPI 1932227915
  NPD (past)

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1730289240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 KENMOOR AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462306",
            "telephone_number": "616-949-6112",
            "fax_number": "616-949-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 KENMOOR AVE SE",
            "address_2": "SUITE 110",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462379",
            "telephone_number": "616-949-6112",
            "fax_number": "616-949-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MEGAN",
        "middle_name": "N",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301065618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3476828",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kylie Clark
• Lauren Clark
• Leanna M Clark
• Lisa Clark, LLP
• Maureen Elizabeth Clark, FNP-C
• Melissa Yvonne Clark, LMSW, CAADC
• Olivia Clark
• Rachel L Clark, MSN, RN, CPNP-PC
• Susan L Clark, ASSOCIATES DEGREE
• Teri Lynn Clark, MSW

• Pediatrics Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; 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.