MICHAEL J CLARK (NPI# 1215967898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215967898 |
| Entity Type | Individual |
| Full Name | MICHAEL J CLARK |
| Credential | DO |
| Practice Address |
1720 Highway 59 S Thief River Falls MN 56701-4331 |
| Practice Telephone | 2186814747 |
| Practice Fax Number | 2186832595 |
| Mailing Telephone | 2186814747 |
| Mailing Fax Number | 2186832595 |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2012-01-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 5746 | ND | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 27254 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MNBS # | 507S2CL | 01 |
| MN | 564508500 | 05 | |
| FM | AMERICA'S PPO/ARAZ # | 2441653 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215534227 | Michael Clark | Contractor | 1107 Lavender Shade Court, Houston, TX 77073 | 2020-10-02 |
| 1558858464 | Michael Clark | Optometrist | 990 Medical Dr Ste G3, Brigham City, UT 84302 | 2018-04-16 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1942715255 | Michael Clark | Physical Medicine & Rehabilitation | 10600 Riverside Drive, Coral Springs, FL 33071-3307 | 2017-12-08 |
| 1386170348 | Michael Clark | Registered Nurse | 317 E 100 N, Price, UT 84501-2504 | 2017-05-11 |
| 1184163982 | Michael Clark | Specialist/Technologist | 19 Second Ave, Auburn, NY 13021-5113 | 2017-02-14 |
| 1356780837 | Michael Clark | Adult Companion | 8305 Concord Dr, Rowlett, TX 75089-2001 | 2013-06-18 |
| 1417394503 | Michael Ray Clark | Pharmacist | 2661 Valleydale Rd, Hoover, AL 35244-2026 | 2013-05-29 |
| 1407143381 | Michael Jeffery Clark | Orthopaedic Surgery | 5671 Peachtree Dunwoody Ste 700, Atlanta, GA 30342-5047 | 2011-06-29 |
| 1700183993 | Michael Brady Clark | Preventive Medicine | 1400 Mckean Rd, Spring House, PA 19477 | 2011-02-24 |
| Street Address |
1720 HIGHWAY 59 S |
| City | THIEF RIVER FALLS |
| State | MN |
| Zip Code | 56701-4331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518915420 | Paul Adams | Psychologist | 1720 Highway 59 S, Northwest Medical Center Mental Health Division, Thief River Falls, MN 56701-4331 | 2006-05-04 |
| 1386047355 | Sanford Health Network North | Clinical Neuropsychologist | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2014-10-03 |
| 1437406907 | Patrick Jahn | Nurse Practitioner | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2012-08-14 |
| 1912261058 | Sanford Health Network North | Family Medicine | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2012-07-03 |
| 1992081020 | Sanford Health Network North | Eyewear Supplier (Equipment, not the service) | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2011-11-03 |
| 1043524465 | Elizabeth L Jahn | Nurse Practitioner | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2010-07-27 |
| 1902122104 | Ann Johnson | Psychologist | 1720 Highway 59 S, Sanford Thief River Falls, Thief River Falls, MN 56701-4331 | 2010-04-13 |
| 1306078118 | Tulasi Kanukuntla | Psychiatry & Neurology | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2009-08-12 |
| 1164603460 | Desiree M Bertilrud | Nurse Practitioner | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2007-11-15 |
| 1962607143 | Sara L Rosendahl | Physician Assistant | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2007-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265885834 | Julia Nelson | Physical Therapist | 1511 Highway 59 S Ste A, Thief River Falls, MN 56701 | 2016-07-19 |
| 1326321167 | Achieve Therapy LLC | Physical Therapist | 201 Brooks Ave, Thief River Falls, MN 56701 | 2011-09-27 |
| 1841581121 | Kathleen G. Barry | Dietitian, Registered | 120 Labree Ave S, Thief River Falls, MN 56701 | 2011-04-21 |
| 1740437789 | Altra Care P A | Clinic/Center | 1140 Vanrooy Dr., Thief River Falls, MN 56701 | 2008-08-21 |
| 1255514477 | Terrence Robert Demars | Social Worker | Meritcare Northwest Medical Center, 120 Labree Ave S, Thief River Falls, MN 56701 | 2007-12-11 |
| 1437290970 | Donna B Helmich | Dentist | 318 La Bree Ave. North, Thief River Falls, MN 56701 | 2007-02-09 |
| 1528129160 | Great Plains Ems, Inc | Ambulance | 511 N Atlantic, Thief River Falls, MN 56701 | 2006-12-13 |
| 1609959022 | John Lloyd Seaverson | Dentist | 318 Labree Ave North, Thief River Falls, MN 56701 | 2006-10-21 |
| 1932280120 | Pennington Health Services | Skilled Nursing Facility | 130 Labree Avenue South, Thief River Falls, MN 56701 | 2006-10-17 |
| 1336232495 | Anderson Hearing Center Ltd | Audiologist | 302 3rd St E, Thief River Falls, MN 56701 | 2006-10-02 |
| Find all providers in zip 56701 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669408753 | Hazem M Sedra | Family Medicine | 213 Labree Ave N Ste 207, Thief River Falls, MN 56701-2022 | 2006-06-23 |
| 1376505115 | Hugh Ben Cowan | Family Medicine | Northwest Medical Center, Thief River Falls, MN 56701 | 2006-04-05 |
| 1972840064 | Sedra Medical Clinic Plc | Family Medicine | 213 Labree Ave N, Suite #207, Thief River Falls, MN 56701-2022 | 2013-01-09 |
| 1912261058 | Sanford Health Network North | Family Medicine | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2012-07-03 |
| 1124381470 | Katherine Joseph | Family Medicine | 3001 Sanford Pkwy, Thief River Falls, MN 56701-2700 | 2012-06-21 |
| 1649562356 | Roy Taylor Klossner | Family Medicine | 3001 Sanford Pkwy, Thief River Falls, MN 56701 | 2011-05-12 |
| 1770635682 | Chandra S Gottipati | Family Medicine | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2007-01-18 |
| 1043302474 | Scott W Petrescue | Family Medicine | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2006-09-30 |
| 1528007630 | Duane C Browning | Family Medicine | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2006-06-05 |
| 1821049180 | Dakota Clinic, Ltd. | Family Medicine | 1720 Highway 59 S, Thief River Falls, MN 56701-4331 | 2006-05-12 |
| Find all providers in THIEF RIVER FALLS | ||||
| City | THIEF RIVER FALLS |
| Zip Code | 56701 |
Please comment or provide details below to improve the information on MICHAEL J CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.