Individual
DR. JOHN GREGORY STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 NICOLLET MALL, SUITE 715, MINNEAPOLIS, MN 55402-2595
(612) 332-2324
(612) 332-1019
Mailing address
825 NICOLLET MALL, SUITE 715, MINNEAPOLIS, MN 55402-2606
(612) 332-2324
(612) 332-1019
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
23369
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-01240
PHP/MEDICA
MN
05
—
126002200
—
MN
01
—
23369
MINNESOTA MEDICAL LICENSE
MN
Enumeration date
01/25/2006
Last updated
03/07/2023
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