Dwayne C Clark (NPI# 1184695975, PAC ID# 4284645391) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1184695975 |
| PAC ID by PECOS | 4284645391 |
| Professional Enrollment ID | I20060605000046 |
| Full Name | Dwayne C Clark |
| Organization Legal Name | AGNESIAN HEALTHCARE INC |
| Address |
145 N Main St Fond Du Lac WI 54935-3423 |
| Phone Number | 9209268722 |
| Gender | M |
| Credential | MD |
| Medical School | DUKE UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1994 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 1658289624 |
| Number of Group Practice Members | 294 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 520088 | ST AGNES HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 145 N Main St, Fond Du Lac, WI 54935-3423 | 9209268722 | AGNESIAN HEALTHCARE INC |
| 420 E Division St, Fond Du Lac, WI 54935-4560 | AGNESIAN HEALTHCARE INC | |
| 430 E Division St, Fond Du Lac, WI 54935-4560 | 9209292300 | AGNESIAN HEALTHCARE INC |
| Organization Legal Name | AGNESIAN HEALTHCARE INC |
| Physicians | 323 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Danielle Covach | Family Medicine | Agnesian Healthcare Inc | 835 Parkside St, Ripon, WI 54971-8505 |
| Kandipati Sreenivasarao | Family Medicine | Agnesian Healthcare Inc | 723 Parkridge Lane, North Fond Du Lac, WI 54937 |
| Matthew R Purcell | Anesthesiology | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Suzanne T Mcgoey | Dermatology | Agnesian Healthcare Inc | 912 S Hickory St, Fond Du Lac, WI 54935-5530 |
| Robert M Bertram | Podiatry | Agnesian Healthcare Inc | 790 Eastgate Dr, Ripon, WI 54971-9614 |
| Shahriar Alizadegan | Vascular Surgery | Agnesian Healthcare Inc | 430 E Division St, Fond Du Lac, WI 54935-4560 |
| Bret N Pasiuk | Nephrology | Agnesian Healthcare Inc | 110 Monroe St, Beaver Dam, WI 53916-2437 |
| Jodi R Budwit | Nurse Practitioner | Agnesian Healthcare Inc | 10 Pluim Dr, Waupun, WI 53963-1564 |
| Bryan J Henslin | Chiropractic | Agnesian Healthcare Inc | 305 Camelot Dr, Fond Du Lac, WI 54935-8014 |
| Jeffrey A Strong | Family Medicine | Agnesian Healthcare Inc | 100 Evergreen Rd, Mt Calvary, WI 53057-9726 |
| Street Address |
145 N MAIN ST |
| City | FOND DU LAC |
| State | WI |
| Zip | 54935-3423 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lynda J Kasper | Family Medicine | Agnesian Healthcare Inc | 145 N Main St, Fond Du Lac, WI 54935-3423 |
| Alexander C Engel | Physician Assistant | Agnesian Healthcare Inc | 145 N Main St, Fond Du Lac, WI 54935-3423 |
| Jessica Y Sullivan | Nurse Practitioner | Agnesian Healthcare Inc | 145 N Main St, Fond Du Lac, WI 54935-3423 |
| Carley J Reinke | Nurse Practitioner | Agnesian Healthcare Inc | 145 N Main St, Fond Du Lac, WI 54935-3423 |
| Jason R Barney | Physical Therapy | Frandsen and Albrecht Physical Therapy Inc | 145 N Main St, Panguitch, UT 84759-0829 |
| Jose C Dias | Family Medicine | Agnesian Healthcare Inc | 145 N Main St, Fond Du Lac, WI 54935-3423 |
| Devin J Albrecht | Physical Therapy | Frandsen and Albrecht Physical Therapy Inc | 145 N Main St, Panguitch, UT 84759-0829 |
| Kent B Hartung | Family Medicine | Agnesian Healthcare Inc | 145 N Main St, Fond Du Lac, WI 54935-3423 |
| Paul R Chambers | Family Medicine | Agnesian Healthcare Inc | 145 N Main St, Fond Du Lac, WI 54935-3423 |
| Oliverio A Garza | Chiropractic | 145 N Main St, Adrian, MI 49221-2711 | |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Matthew R Purcell | Anesthesiology | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Ruth A Adene- Peter | Hospitalist | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Nicole A Hostetler | Nurse Practitioner | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Nydia C Ros | Hospitalist | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Cynthia M Griffin | Emergency Medicine | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Kelly M Olsen | Certified Registered Nurse Anesthetist (crna) | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Jennifer I Giesige | Psychiatry | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Abigail I Ruh | Psychologist, Clinical | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Michelle C Pesek Mccoy | Emergency Medicine | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Kristof T Gehrke | Critical Care (intensivists) | Agnesian Healthcare Inc | 430 E Divsion St, Fond Du Lac, WI 54935 |
| Find all physicians in zip 54935 | |||
| City | FOND DU LAC |
| Zip Code | 54935 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | FOND DU LAC + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Dwayne C Clark.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.