Individual
KENNETH E STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
045588
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370164600
—
FL
Enumeration date
12/14/2005
Last updated
10/09/2012
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