Provider Demographics
NPI:1790086460
Name:STARKS, CHESTER JR (RCIS,RCS)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:
Last Name:STARKS
Suffix:JR
Gender:M
Credentials:RCIS,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 POLK ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-1120
Mailing Address - Country:US
Mailing Address - Phone:219-895-9695
Mailing Address - Fax:
Practice Address - Street 1:1149 POLK ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-3808
Practice Address - Country:US
Practice Address - Phone:219-895-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00039743246XC2901X, 246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN246XS1301XMedicare PIN
IN246X00000XMedicare PIN