Provider Demographics
NPI:1912541467
Name:STARSIAK OSTEOPATHIC CLINIC LLC
Entity Type:Organization
Organization Name:STARSIAK OSTEOPATHIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STARSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-410-9978
Mailing Address - Street 1:3145 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-1875
Mailing Address - Country:US
Mailing Address - Phone:317-410-9978
Mailing Address - Fax:
Practice Address - Street 1:3955 EAGLE CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4692
Practice Address - Country:US
Practice Address - Phone:317-410-9978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty