Provider Demographics
NPI:1891884789
Name:MARKON, CLYDE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:EDWARD
Last Name:MARKON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 QUEBEC AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3833
Mailing Address - Country:US
Mailing Address - Phone:763-537-7671
Mailing Address - Fax:
Practice Address - Street 1:3520 TOWER AVE
Practice Address - Street 2:TWIN PORTS OUTPATIENT CLINIC
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880
Practice Address - Country:US
Practice Address - Phone:715-398-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32188207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology