Provider Demographics
NPI:1003831298
Name:CLINARD, MARTIN JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:JOSEPH
Last Name:CLINARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 S DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3234
Mailing Address - Country:US
Mailing Address - Phone:269-343-1296
Mailing Address - Fax:269-344-8485
Practice Address - Street 1:501 S DRAKE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3234
Practice Address - Country:US
Practice Address - Phone:269-343-1296
Practice Address - Fax:269-344-8485
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004170363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N88760Medicare PIN