Provider Demographics
NPI:1487657326
Name:STARK, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:STARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2000 REGENCY CT
Mailing Address - Street 2:STE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3075
Mailing Address - Country:US
Mailing Address - Phone:419-841-6600
Mailing Address - Fax:419-841-6677
Practice Address - Street 1:2000 REGENCY CT
Practice Address - Street 2:STE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3075
Practice Address - Country:US
Practice Address - Phone:419-841-6600
Practice Address - Fax:419-841-6677
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH042794208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0488502Medicaid
MI104389683OtherMICHIGAN MEDICAID
OHA80355Medicare UPIN
OH0513213Medicare PIN
OHH034190Medicare PIN