Provider Demographics
NPI:1699904086
Name:CREGER, CLARK MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:MATTHEW
Last Name:CREGER
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 1:33155 ANNAPOLIS ST
Mailing Address - Street 2:OFFICE OF MEDICAL EDUCATION
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2405
Mailing Address - Country:US
Mailing Address - Phone:734-467-2482
Mailing Address - Fax:
Practice Address - Street 1:29150 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2848
Practice Address - Country:US
Practice Address - Phone:734-762-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine