Individual
DR. MICHAEL E. STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
042794
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0488502
—
OH
01
—
104389683
MICHIGAN MEDICAID
MI
Enumeration date
05/24/2005
Last updated
01/05/2012
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