Individual
JANE M STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
Mailing address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
30562
WI
2083P0901X
Public Health & General Preventive Medicine Physician
30562-20
WI
2083X0100X
Occupational Medicine Physician
Primary
30562-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780785253
—
WI
Enumeration date
09/26/2006
Last updated
11/24/2021
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