Provider Demographics
NPI:1336219690
Name:STARACE, LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:STARACE
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 1:6231 PGA BLVD
Mailing Address - Street 2:SUITE 104-123
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4033
Mailing Address - Country:US
Mailing Address - Phone:561-972-4645
Mailing Address - Fax:561-972-4839
Practice Address - Street 1:6231 PGA BLVD
Practice Address - Street 2:SUITE 104-123
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4033
Practice Address - Country:US
Practice Address - Phone:561-972-4645
Practice Address - Fax:561-972-4839
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98453207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5C3916OtherHEALTHNET #
NYRS365OtherOXFORD #
NY200009519OtherRAILROAD MEDICARE #
NY109715OtherWELLCARE #
NY0500258OtherGHI PPO #
NY0056369OtherAETNA HMO#
NY132670769OtherTAX ID#
NY362563OtherMVP #
NY156861OtherHIP #
NY4294790OtherAETNA PPO#
NY96D061OtherEMPIRE BCBS #
NY0056369OtherAETNA HMO#
NYRS365OtherOXFORD #
NYA65068Medicare UPIN
NY200009519OtherRAILROAD MEDICARE #
NY4294790OtherAETNA PPO#