MEDICARE: STARSIAK OSTEOPATHIC CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225700000X	Massage Therapist
2	363L00000X	Nurse Practitioner
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1912541467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARSIAK OSTEOPATHIC CLINIC LLC

Provider Business Mailing Address
First Line	:	3145 SUMMERFIELD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1875
Country	:	US
Telephone Number	:	317-410-9978
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 EAGLE CREEK PKWY STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4692
Country	:	US
Telephone Number	:	317-410-9978
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM DAVID STARSIAK
Credential	:	DO
Telephone Number	:	317-410-9978

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/29/2019

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