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Contact Information

TERRY L CLARK, DPM
728 PENNSYLVANIA AVE
SHEBOYGAN, WI53081-4669
 Phone: 920-803-8014
 Fax: 920-803-8015
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for TERRY L CLARK · (Male)

NPI Number 1326008277
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 03/24/2006
Last updated 07/09/2007 - About 19 years ago
Sole proprietor 1 Not specified
Identifiers
  • UT License # 105334-0501
  • WI License # 649-025
  • WI Medicaid 43213700
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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