Active NPI
Michael Clark
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Coral Springs, FL
National Provider Identifier
1942715255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 1624
- Practice address
- 10600 Riverside Drive
Coral Springs, FL 33071-3307 - Phone
- (954) 812-5661
- Fax
- (954) 812-5661
- NPI assigned
- Dec 8, 2017
- 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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 1624 | FL | Primary |
Addresses
Primary practice location
10600 Riverside Drive
Coral Springs, FL 33071-3307
Mailing address
3192 Merrick Terrace
Margate, FL 33063
Phone (954) 812-5661
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1624 | FL | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512691200000",
"number": "1942715255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3192 MERRICK TERRACE",
"city": "MARGATE",
"state": "FL",
"postal_code": "33063",
"telephone_number": "954-812-5661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10600 RIVERSIDE DRIVE",
"city": "CORAL SPRINGS",
"state": "FL",
"postal_code": "330713307",
"telephone_number": "954-812-5661",
"fax_number": "954-812-5661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-08",
"last_updated": "2017-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "FL",
"license": "1624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coral Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.