Dr. Kenneth Clark , MD
Specialist • Milwaukee, WI
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kenneth Clark has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Kenneth Clark, MD was a registered Specialist practicing in Milwaukee, WI. Throughout an active medical career spanning 1 years, Dr. Clark provided care at the practice location at 2025 E NEWPORT AVE until profile deactivation on 2005-12-09.
Practice Location & Contact Primary Location
2025 E Newport Ave
Milwaukee, WI 532112906
Specialty Benchmarks & Practice Insights
Comparative analytics for Specialist in Milwaukee, WI
Practicing in Milwaukee, WI (312 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 174400000X
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Practice Associates & Co-Workers
Healthcare professionals and specialists practicing at this location or sharing practice phone/fax
Radiology - Diagnostic Radiology
Doctor of Medicine (M.D.)
Specialist
Doctor of Medicine (M.D.)
Specialist
Doctor of Medicine (M.D.)
Specialist
Doctor of Medicine (M.D.)
Specialist
Doctor of Medicine (M.D.)
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Registered at 2025 E NEWPORT AVE, MILWAUKEE, WI 532112906 (Tel: 4149613841)
Registered at 500 W BROWN DEER RD, SUITE 202, BAYSIDE, WI 532171627
Recorded as KENNETH CLARK, M.D.
Specialist (License #22673 in WI)
Record officially reactivated for active practice on April 05, 2006
Record deactivated on December 09, 2005
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
500 W Brown Deer Rd, Suite 202
Bayside, WI 532171627
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