Provider Demographics
NPI:1154682409
Name:STARKS, JAMIE LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LEIGH
Last Name:STARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 VETERANS DR # 11G
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-1565
Mailing Address - Fax:612-725-2084
Practice Address - Street 1:1 VETERANS DR # 11G
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1565
Practice Address - Fax:612-725-2084
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MN623842084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No174H00000XOther Service ProvidersHealth Educator