Provider Demographics
NPI:1528041084
Name:STARKEY, LISA MARY (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARY
Last Name:STARKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:STE #705
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6215
Mailing Address - Country:US
Mailing Address - Phone:248-552-9858
Mailing Address - Fax:248-552-9510
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:STE #705
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6215
Practice Address - Country:US
Practice Address - Phone:248-552-9858
Practice Address - Fax:248-552-9510
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704146061207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
7597565OtherAETNA PIN
MI4648426Medicaid
ON85520Medicare ID - Type Unspecified
MI4648426Medicaid