Provider Demographics
NPI:1548206527
Name:STARKS, HUGH B (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:B
Last Name:STARKS
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:P O BOX 269358
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:IN
Mailing Address - Zip Code:46226-9358
Mailing Address - Country:US
Mailing Address - Phone:317-755-2866
Mailing Address - Fax:
Practice Address - Street 1:8401 HARCOURT ROAD #3031
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-3031
Practice Address - Country:US
Practice Address - Phone:317-338-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK57832084P0800X, 2084P0804X
IN01066052A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3743Medicaid