Provider Demographics
NPI:1376505404
Name:STARK, HENRY KAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:KAY
Last Name:STARK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2503
Mailing Address - Country:US
Mailing Address - Phone:561-284-6886
Mailing Address - Fax:561-627-2199
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2503
Practice Address - Country:US
Practice Address - Phone:561-284-6886
Practice Address - Fax:561-627-2199
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1272213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029743700Medicaid
FLT55502Medicare UPIN
FL029743700Medicaid