IAN LAURENCE CLARK MD
NPI 1609567643
Student in an Organized Health Care Education/Training Program in Kalamazoo, MI

Q: What is Ian Clark's NPI number?

The NPI number for Ian Clark is 1609567643. It was assigned to this individual provider in the NPPES registry on May 19, 2023.

Q: What is Ian Clark's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Ian Clark was last updated on June 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 19, 2023PECOS Enrolled

1000 OAKLAND DR, KALAMAZOO, MI 49008(269) 337-4600 Get Directions Write a Review

NPPES record last updated: June 22, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 22, 2023, May 19, 2023 (2 updates tracked since 2023).

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About Ian Laurence Clark Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IAN LAURENCE CLARK MD (NPI 1609567643) is an individual student in an organized health care education/training program in Kalamazoo, Michigan, licensed in Michigan (4351051369) and active in the NPI registry since May 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1609567643

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameIAN LAURENCE CLARKCredential: MD

Location Address1000 OAKLAND DRKalamazoo, MI 49008-1282

Mailing Address1000 Oakland DrKalamazoo, MI 49008-1282

Phone(269) 337-4600

Sole ProprietorNo

Enumeration DateMay 19, 2023

Last NPPES UpdateJune 22, 20232 updates tracked since enumeration

NPPES CertifiedJune 22, 2023

✔ NPI 1609567643 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MI · 4351051369

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1000 OAKLAND DR, Kalamazoo, MI 49008

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ian Laurence Clark Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREW MATTINGLY MD

Student in an Organized Health Care Education/Training Program