| Doctor Name: | MR. DANIEL CLARK |
| NPI Number: | 1043613649 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NURSE PRACITIONER |
| License Number: | 4704269853 |
| Business Practice Address: | 3451 Bald Mountain Rd Lake Orion, MI - 483602401 |
| Business Phone Number: | 2483305808 |
| Business Fax Number: | |
| Mailing Address: | 3451 Bald Mountain Rd, LAKE ORION |
| State: | MI |
| Postal Code: | 483602401 |
| Phone Number: | 2483305808 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2014 |
| NPI Last Update Date: | 09/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704269853 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |