Individual
DR. MICHAEL DILLARD STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2400 17TH ST, COLUMBUS, IN 47201-5351
(812) 376-5016
(812) 376-5928
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
11013994A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000983427
ANTHEM PIN
IN
05
—
200955430
—
IN
Enumeration date
07/15/2008
Last updated
09/09/2024
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