Active NPI
William Thomas Clark, PA-C
- Physician Assistant
- Ann Arbor, MI
National Provider Identifier
1841318854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA003508
- Practice address
- 2215 Fuller Rd
Sticu
Ann Arbor, MI 48105-2303 - Phone
- (734) 769-7100
- NPI assigned
- Mar 27, 2007
- Last updated
- Jan 25, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA003508 | PA | Primary |
Addresses
Primary practice location
2215 Fuller Rd
Sticu
Ann Arbor, MI 48105-2303
Mailing address
3036 Gadwall LN
Ypsilanti, MI 48197-8731
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA003508 | PA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453680000000",
"number": "1841318854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3036 GADWALL LN",
"city": "YPSILANTI",
"state": "MI",
"postal_code": "481978731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2215 FULLER RD",
"address_2": "STICU",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481052303",
"telephone_number": "734-769-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "WILLIAM",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2016-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA003508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.