Provider Demographics
NPI:1245212075
Name:STARK, CRAIG A (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:STARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1416
Mailing Address - Country:US
Mailing Address - Phone:515-241-5700
Mailing Address - Fax:515-241-5775
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:SUITE 414
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-5700
Practice Address - Fax:515-241-5775
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-23727207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01173061OtherRR MEDICARE
IA6206847Medicaid
IA1245212075Medicaid
IA719260562Medicare PIN
IAP01173061OtherRR MEDICARE
IA719260562Medicare PIN