Provider Demographics
NPI:1588626246
Name:CONANT, CLARK EDWIN III (DO)
Entity Type:Individual
Prefix:MS
First Name:CLARK
Middle Name:EDWIN
Last Name:CONANT
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:300 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2180
Mailing Address - Country:US
Mailing Address - Phone:517-782-8223
Mailing Address - Fax:517-782-6670
Practice Address - Street 1:300 W WASHINGTON AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2180
Practice Address - Country:US
Practice Address - Phone:517-782-8223
Practice Address - Fax:517-782-6670
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2024-03-30
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Provider Licenses
StateLicense IDTaxonomies
MI51006900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3064119Medicaid
MI5381884Medicare ID - Type Unspecified
MI3064119Medicaid