Provider Demographics
NPI:1407804883
Name:STARK, WILLIAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
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 1:9233 WARD PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3366
Mailing Address - Country:US
Mailing Address - Phone:816-389-6030
Mailing Address - Fax:816-389-6034
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:816-389-6030
Practice Address - Fax:816-389-6034
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0427896207L00000X
MOR9N71207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO050063985OtherMO RR MEDICARE NUMBER
KS050070668OtherKS RR MEDICARE NUMBER
KS17456024OtherBCBS NUMBER
MO17456084OtherBCBS NUMBER
MO100126100BMedicaid
MO203000039Medicaid
KS100126100DMedicaid
KS203000070Medicaid
MO100126100BMedicaid
KSE87061Medicare UPIN
MOE87061Medicare UPIN
KSJ882677Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER