RYAN WILLIAM CLARK (NPI# 1720499759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720499759 |
| Entity Type | Individual |
| Full Name | RYAN WILLIAM CLARK |
| Credential | D.O. |
| Practice Address |
12203 Corporate Pkwy Mequon WI 53092 |
| Mailing Address |
12203 Corporate Pkwy Mequon WI 53092-3388 |
| Practice Telephone | 2623878200 |
| Practice Fax Number | 2623878239 |
| Mailing Telephone | 2623878200 |
| Mailing Fax Number | 2623878239 |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2020-04-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
67188-21 | WI | Allopathic & Osteopathic Physicians |
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
67188 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 100068648 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114525748 | Ryan Scott Clark | Chiropractor | 1416 N Redwood Rd Ste B, Saratoga Springs, UT 84045-6455 | 2020-10-15 |
| 1528626959 | Ryan Steven Clark | Student in an Organized Health Care Education/Training Program | 212 Farm Road, #201, Moscow, ID 83843 | 2019-05-31 |
| 1710449384 | Ryan Clark | Specialist/Technologist | 2431 Alteras Dr, Nashville, TN 37211-7279 | 2019-04-03 |
| 1780068718 | Ryan Clark | Student in an Organized Health Care Education/Training Program | 6749 Springview Dr, Westerville, OH 43082-8566 | 2015-07-20 |
| 1689061822 | Ryan Clark | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 N 1900 E Som 3c127, Salt Lake City, UT 84132 | 2015-04-24 |
| 1184903460 | Ryan Mathew Clark | Anesthesiologist Assistant | 1500 N Oakland, Bolivar, MO 65613-3099 | 2011-08-04 |
| 1356639892 | Ryan James Clark | Dentist | 580 W Parkcenter Blvd Ste B, Boise, ID 83706 | 2011-07-19 |
| 1114924149 | Ryan N. Clark | Specialist/Technologist | 1931 Burlington St, North Kansas City, MO 64116-3407 | 2005-07-06 |
| 1518458611 | Ryan Alexander Clark | Specialist/Technologist | 2901 S Santa Fe Ave, Moore, OK 73160-2843 | 2018-05-23 |
| 1508212721 | Ryan Clark | Taxi | 400 W Main St, La Porte City, IA 50651-1027 | 2016-05-06 |
| Street Address |
12203 CORPORATE PKWY |
| City | MEQUON |
| State | WI |
| Zip Code | 53092 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346235058 | East Mequon Surgery Center LLC | Clinic/Center | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2005-09-19 |
| 1477187649 | Andrew M Oswald | Physician Assistant | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2020-02-26 |
| 1174018584 | Ashley A Mcguire | Family Medicine | 12203 Corporate Pkwy, Mequon, WI 53092 | 2018-06-27 |
| 1053839571 | Annette S Harris | Nurse Practitioner | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2017-09-05 |
| 1568843696 | Mikhail Eiseler | Family Medicine | 12203 Corporate Pkwy, Mequon, WI 53092 | 2015-06-15 |
| 1548640774 | Brant Michael Balthazor | Physician Assistant | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2015-06-03 |
| 1316382211 | Heidi Rae Schmidt | Physician Assistant | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2013-05-06 |
| 1285966101 | Kristin M Shtulberg | Registered Nurse | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2010-02-02 |
| 1487894267 | Joe Lipp Jr. | Specialist/Technologist, Other | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2009-03-06 |
| 1063680593 | Pamela Lee | Registered Nurse | 12203 Corporate Pkwy, Mequon, WI 53092-3388 | 2008-02-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942790761 | Kathryn Mueller | Specialist/Technologist | 117 Linden Lane, Apt 7, Thiensville, WI 53092 | 2018-05-17 |
| 1427547082 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 10996 N Port Washington Rd, Mequon, WI 53092 | 2018-05-08 |
| 1912437252 | Froedtert & The Medical College of Wisconsin Community Physicians Inc | Durable Medical Equipment & Medical Supplies | 11430 Port Washington Road, Mequon, WI 53092 | 2017-06-19 |
| 1629437256 | Sean S Tsang | Acupuncturist | 909 W. Mequon Rd., Mequon, WI 53092 | 2016-02-10 |
| 1497128433 | Nancy Snoots | Counselor | 4430 W Tarrytown Ln, Mequon, WI 53092 | 2015-11-12 |
| 1609265214 | Evan Guettel | Physical Therapist | 11363 N. Port Washington Road, Mequon, WI 53092 | 2015-01-20 |
| 1881091148 | Sarah Krueger | Counselor | 216 N Green Bay Rd Suite 108, Thiensville, WI 53092 | 2014-12-01 |
| 1245667088 | Lora Transportation, LLC | Non-emergency Medical Transport (VAN) | 1228 West Baldwin Crt., Mequon, WI 53092 | 2013-10-10 |
| 1710314000 | Roxxi M Davis | Social Worker | 7113 Tamarack Ct, Mequon, WI 53092 | 2013-10-01 |
| 1225473713 | Forefront Dermatology, S.c. | Dermatology | 10303 N Port Washington Rd Ste 101, Mequon, WI 53092 | 2013-05-09 |
| Find all providers in zip 53092 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790309276 | Wisconsin Spine and Pain Sc | Pain Medicine | 1604 Cedar Bnd, Hartland, WI 53029-8663 | 2020-06-01 |
| 1679119689 | Pain Physicians of Wisconsin, Sc | Pain Medicine | 5007 S Howell Ave Ste 115, Milwaukee, WI 53207-6158 | 2019-11-25 |
| 1619359122 | Pain Relief, Inc. | Pain Medicine | 7520 Us Highway 51, Nwbj, Minocqua, WI 54548-8943 | 2015-06-19 |
| 1093001851 | Brian Curtin | Pain Medicine | 525 W River Woods Pkwy Ste 240, Glendale, WI 53212-1010 | 2011-06-21 |
| 1285924969 | Thomas J. Guhl, M.d., S.c. | Pain Medicine | 3305 S 20th St Ste 150, Milwaukee, WI 53215-4941 | 2011-04-14 |
| 1457459869 | Nichole Virgo | Pain Medicine | 8901 N 76th St Fl 3, Milwaukee, WI 53223-1901 | 2006-09-20 |
| 1740889021 | Midwest Interventional Pain and Diagnostics | Pain Medicine | 525 W River Woods Pkwy Ste 240, Glendale, WI 53212-1010 | 2020-10-19 |
| 1750791901 | David L. Scherwinski, M.d., S.c. | Pain Medicine | 140 24th St S, Wisconsin Rapids, WI 54494-1906 | 2014-04-28 |
| 1275799264 | Alberto C Clar Md Sc | Pain Medicine | 8901 N 76th St, Milwaukee, WI 53223-1901 | 2008-07-30 |
| 1619154952 | Pritika Bhatia, M.d., LLC. | Pain Medicine | 3305 S 20th St, Ste 150, Milwaukee, WI 53215-4940 | 2008-01-29 |
| Find all providers with the same taxonomy | ||||
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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.