Healthcare Provider Details

I. General information

NPI: 1083989172
Provider Name (Legal Business Name): MICHELLE CASEY STARR MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5119
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2563
  • Fax:
Mailing address:
  • Phone: 317-777-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML60292595
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number01082551A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: