Provider Demographics
NPI:1457422172
Name:KAREN A CLARK MD PA
Entity Type:Organization
Organization Name:KAREN A CLARK MD PA
Other - Org Name:ASPEN CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-537-1070
Mailing Address - Street 1:2450 E SHOW LOW LAKE RD
Mailing Address - Street 2:2A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7953
Mailing Address - Country:US
Mailing Address - Phone:928-537-1070
Mailing Address - Fax:928-537-1064
Practice Address - Street 1:2450 E SHOW LOW LAKE RD
Practice Address - Street 2:2A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7953
Practice Address - Country:US
Practice Address - Phone:928-537-1070
Practice Address - Fax:928-537-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32348207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty