Provider Demographics
NPI:1851370860
Name:STARK, WARREN CARLTON (DO)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:CARLTON
Last Name:STARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD STE 360
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1167
Mailing Address - Country:US
Mailing Address - Phone:816-276-7600
Mailing Address - Fax:816-276-7090
Practice Address - Street 1:6675 HOLMES RD
Practice Address - Street 2:STE 360
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1150
Practice Address - Country:US
Practice Address - Phone:816-276-7600
Practice Address - Fax:816-276-7992
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR7B79207Q00000X
MOR7B79207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241593250Medicaid
KS100236920BMedicare Oscar/Certification
MOP00117500Medicare PIN
MOP539044Medicare Oscar/Certification
MO241593250Medicaid