Provider Demographics
NPI:1356338107
Name:STARENCHAK, SCOTT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:STARENCHAK
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-996-8103
Mailing Address - Fax:314-996-3230
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV IM GENERAL MED, STE 330
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-996-8103
Practice Address - Fax:314-996-3230
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021048490207Q00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200112559Medicaid
PAI39371Medicare UPIN
PACG1496Medicare PIN
PA1015642360002Medicaid
PA093939R7RMedicare PIN