Provider Demographics
NPI:1861026205
Name:OKULSKI, CLARK J (DO)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:J
Last Name:OKULSKI
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 1:15366 WINDMILL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1744
Mailing Address - Country:US
Mailing Address - Phone:313-822-9650
Mailing Address - Fax:
Practice Address - Street 1:15366 WINDMILL POINTE DR
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1744
Practice Address - Country:US
Practice Address - Phone:313-822-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005838207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery