Provider Demographics
NPI:1174026728
Name:CLARKE, KIEL (DO)
Entity Type:Individual
Prefix:
First Name:KIEL
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3025
Mailing Address - Country:US
Mailing Address - Phone:716-297-1027
Mailing Address - Fax:716-298-4081
Practice Address - Street 1:6950 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3025
Practice Address - Country:US
Practice Address - Phone:716-297-1027
Practice Address - Fax:716-298-4081
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine