DR. JACK LEWIS CLARK (NPI# 1588616882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588616882 |
| Entity Type | Individual |
| Full Name | DR. JACK LEWIS CLARK |
| Credential | M.D. |
| Practice Address |
21700 Northwestern Hwy Suite 1290 Southfield MI 48075-4906 |
| Mailing Address |
27260 Hampstead Blvd Farmington Hills MI 48331-3678 |
| Practice Telephone | 2485572100 |
| Practice Fax Number | 2485579220 |
| Mailing Telephone | 2485572100 |
| Mailing Fax Number | 2485579220 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2010-07-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | 3855778020 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 3402154 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083840342 | Jack R Clark | Dentist | 1856 Lancaster Rd, Homewood, AL 35209-4114 | 2009-06-01 |
| 1265571608 | Jack Douglas Clark | Ophthalmology | 7112 N Fresno St, Suite 100, Fresno, CA 93720-2940 | 2007-02-05 |
| 1346320140 | Jack Prow Clark | Family Medicine | 518 Ems D15 Ln, Syracuse, IN 46567-8026 | 2006-10-16 |
| 1306824016 | Jack Crowley Clark Sr. | Radiology | 1431 Centerpoint Blvd, Teamhealth Radiology Ste 100, Knoxville, TN 37932-1984 | 2006-01-03 |
| 1902881014 | Jack J Clark | Chiropractor | 6015 E State Blvd, Fort Wayne, IN 46815-7638 | 2005-12-12 |
| 1477799112 | Jack Clark | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2008-12-31 |
| 1841311487 | Jack Malcolm Clark IIi | Social Worker | 7711 Madonna, San Antonio, TX 78216-6620 | 2007-04-02 |
| 1902992837 | Jack O. Clark | Internal Medicine | 450 E Main St, Rexburg, ID 83440 | 2006-10-05 |
| 1427092857 | Jack C Clark | Family Medicine | 103 Midlake Dr, Knoxville, TN 37918-3039 | 2006-06-15 |
| 1073563847 | Jack Clark | Internal Medicine | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2006-05-11 |
| Street Address |
21700 NORTHWESTERN HWY SUITE 1290 |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075-4906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821092750 | Nagashree Chandrashekar | Internal Medicine | 21700 Northwestern Hwy, Ste 600, Southfield, MI 48075-4912 | 2005-06-09 |
| 1457892762 | Care Holdings, LLC | Behavioral Analyst | 21700 Northwestern Hwy, Suite 870, Southfield, MI 48075-4906 | 2017-03-20 |
| 1871928200 | Manor House I.d.l.s. | In Home Supportive Care | 21700 Northwestern Hwy, Suite 880, Southfield, MI 48075-4906 | 2013-09-04 |
| 1548694177 | Glory Adult Day Program | Day Training, Developmentally Disabled Services | 21700 Northwestern Hwy, Suite 880, Southfield, MI 48075-4906 | 2013-08-30 |
| 1326472457 | Manor House Palliative and Hospice Care LLC | Hospice Care, Community Based | 21700 Northwestern Hwy, Suite 880, Southfield, MI 48075-4906 | 2013-08-26 |
| 1427301639 | Carol Jean Schiller | Counselor | 21700 Northwestern Hwy, Suite 1490, Southfield, MI 48075-4906 | 2012-10-25 |
| 1578814984 | First Response Ems, Inc | Ambulance | 21700 Northwestern Hwy, Southfield, MI 48075-4906 | 2012-09-25 |
| 1689922122 | Kristy Yglesias | Non-emergency Medical Transport (VAN) | 21700 Northwestern Hwy, Suite 875, Southfield, MI 48075-4906 | 2012-08-15 |
| 1346511060 | Kathleen A Redlawsk | Massage Therapist | 21700 Northwestern Hwy, Suite 110, Southfield, MI 48075-4906 | 2012-01-26 |
| 1477833986 | Robyn Grieve | Acupuncturist | 21700 Northwestern Hwy, Suite 660, Southfield, MI 48075-4906 | 2011-08-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366648909 | Clayman & Riley PC | Oral & Maxillofacial Surgery | 29355 Northwestern Hwy, Suite # 200, Southfield, MI 48034-1053 | 2007-06-21 |
| 1083819601 | Clayman & Riley PC | Oral & Maxillofacial Surgery | 29355 Northwestern Hwy, Suite # 200, Southfield, MI 48034-1053 | 2007-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760900120 | Cynthia A Rider Dmd Pllc | Oral & Maxillofacial Surgery | 2545 Spring Arbor Road, Suite 202, Jackson, MI 49203 | 2017-09-06 |
| 1881792786 | James W Lepczyk | Oral & Maxillofacial Surgery | 31100 Telegraph, Suite 100, Bingham Farms, MI 48025 | 2006-09-21 |
| 1558472332 | Richard F Scott Dds Ms PC | Oral & Maxillofacial Surgery | 203 S Zeeb Road, Suite 101, Ann Arbor, MI 48103 | 2006-08-31 |
| 1922115633 | Nick Leone | Oral & Maxillofacial Surgery | 28018 Harper Avenue, St Clair Shores, MI 48081 | 2006-08-25 |
| 1598772626 | Oral & Maxillofacial Surgery Associates of Western Michigan Plc | Oral & Maxillofacial Surgery | 2140 Lake Michigan Dr Nw, Grand Rapids, MI 49504-4785 | 2006-08-02 |
| 1831113125 | Jeffery Mcfadden | Oral & Maxillofacial Surgery | 33111 W. Seven Mile Rd., Livonia, MI 48152 | 2006-07-27 |
| 1215950100 | William S Bloom | Oral & Maxillofacial Surgery | 11300 East Thirteen Mile Road, Warren, MI 48093 | 2006-07-25 |
| 1609809250 | Richard Peter Bartling | Oral & Maxillofacial Surgery | 3011 Abigail Ln, Midland, MI 48640 | 2006-07-08 |
| 1710949953 | Robert Harry Burke | Oral & Maxillofacial Surgery | 2260 S Huron Pkwy, Ann Arbor, MI 48104-5151 | 2006-04-04 |
| 1497728380 | Brian H Cohen | Oral & Maxillofacial Surgery | 2120 Monroe St, Dearborn, MI 48124-2943 | 2006-02-10 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
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| 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.