Provider Demographics
NPI:1437391992
Name:CLARK, ANNE KOWATSCH (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KOWATSCH
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 MCFARLAND LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-4708
Mailing Address - Country:US
Mailing Address - Phone:317-862-2700
Mailing Address - Fax:317-865-2711
Practice Address - Street 1:7830 MCFARLAND LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-4708
Practice Address - Country:US
Practice Address - Phone:317-865-2700
Practice Address - Fax:317-865-2711
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0107044208D00000X
IN01070944A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201085570Medicaid