MEDICARE: ALI STARKES MEDICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336472240	OTHER	CA	NPI FOR ENTITY
2	FNP 39429	OTHER	CA	BOARD OF MEDICINE (FICTITOUS NAME PERMIT)

General Provider Information

NPI Number	:	1962736090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI STARKES MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3605 AGNETA CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7408
Country	:	US
Telephone Number	:	916-501-0728
Fax Number	:	916-683-9604

Provider Business Practice Location Address
First Line	:	8325 ELK GROVE FLORIN RD
Second Line	:	SUITE 800
City	:	SACRAMENTO
State	:	CA
Zip	:	95829-9523
Country	:	US
Telephone Number	:	916-501-0728
Fax Number	:	916-683-9604

Authorized Official
Title or Position	:	MANAGING ADMINSTRATOR
Name	:	MARGARET KAPASI
Credential	:
Telephone Number	:	916-501-0728

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	06/04/2010

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