Individual provider · NPI-1

Clark Thomas Eddy, DO

Family Medicine · Shawnee Mission, KS

NPI number1962609941
StatusActive
Last updated in NPPESApr 6, 2018

Details

NPI
1962609941
Entity type
Individual (NPI-1)
Name
Clark Thomas Eddy
Credential
DO
Sex
Male
Sole proprietor
No
Enumeration date
Jul 2, 2007
Last updated
Apr 6, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine05-33757KSYes

Practice location

9100 W 74th St
Shawnee Mission, KS 66204-4004

Phone 913-676-2000

Mailing address

36123 Schoolcraft Rd
Livonia, MI 48150-1216

Phone 913-660-1616 · Fax 913-660-0998

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