Provider Demographics
NPI:1912124710
Name:CLARKE, STEVEN ELLIOT (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ELLIOT
Last Name:CLARKE
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 1:301 W RIVER PKWY APT 103
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-3375
Mailing Address - Country:US
Mailing Address - Phone:612-332-9110
Mailing Address - Fax:612-871-1126
Practice Address - Street 1:301 W RIVER PKWY APT 103
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-3375
Practice Address - Country:US
Practice Address - Phone:612-332-9110
Practice Address - Fax:612-871-1126
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN271162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry