Organization
KENNETH E STARK MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH E STARK MD (PHYSICIAN)
(352) 343-7735
Entity
Organization
Contact information
Practice address
1613 BANNING BEACH RD, TAVARES, FL 32778-2024
(352) 343-7735
(352) 343-7740
Mailing address
1613 BANNING BEACH RD, TAVARES, FL 32778-2024
(352) 343-7735
(352) 343-7740
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
ME0045588
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09127
BCBS OF FLORIDA
FL
05
—
370164600
—
FL
01
—
6515425
CIGNA
FL
Enumeration date
11/16/2007
Last updated
11/16/2007
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