Provider Demographics
NPI:1679539811
Name:CLANCY, JAMES PATRICK III (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:CLANCY
Suffix:III
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2990 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8607
Mailing Address - Country:US
Mailing Address - Phone:269-983-3368
Mailing Address - Fax:269-983-2758
Practice Address - Street 1:2990 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8607
Practice Address - Country:US
Practice Address - Phone:269-983-3368
Practice Address - Fax:269-983-2758
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301 060275208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4170377 10Medicaid
WI100257957Medicaid
MI4170377 10Medicaid