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Individual

STEPHEN H STARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
308 W HIGHLAND BLVD, INVERNESS, FL 34452-4716
(352) 726-8353
(352) 726-5038
Mailing address
308 W HIGHLAND BLVD, INVERNESS, FL 34452-4716
(352) 726-8353
(352) 726-5038

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
ME30869
FL
207RI0011X
Interventional Cardiology Physician
Primary
ME30869
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
056651900
FL
01
10721764
CAQH
FL
01
2569084
CIGNA
FL
01
269859500
MEDICAID GROUP
FL
01
30064
BCBS
FL
01
77940
MEDICARE GROUP ID
FL
01
77940
BCBS GRP
01
CF1416
MEDICARE RR GROUP
FL
01
ME30869
STATE LICENSE NUMBER
FL
01
P00144401
MEDICARE RR
FL
Enumeration date
12/01/2005
Last updated
10/09/2009
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