Provider Demographics
NPI:1366467185
Name:TARTER, STANLEY KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:KEITH
Last Name:TARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10592 LIGHTHOUSE PT
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9294
Mailing Address - Country:US
Mailing Address - Phone:313-791-4802
Mailing Address - Fax:
Practice Address - Street 1:10592 LIGHTHOUSE PT
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9294
Practice Address - Country:US
Practice Address - Phone:313-791-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010534782083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine