Individual
JULIE MARIA STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
436 E WASHINGTON BLVD, FORT WAYNE, IN 46802-3210
(260) 209-7111
(260) 222-2835
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01073161A
IN
207Q00000X
Family Medicine Physician
036121864
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201190690
—
IN
Enumeration date
05/04/2007
Last updated
08/19/2024
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