Healthcare Provider Details

I. General information

NPI: 1548206527
Provider Name (Legal Business Name): HUGH B STARKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HARCOURT ROAD #3031
INDIANAPOLIS IN
46260-3031
US

IV. Provider business mailing address

P O BOX 269358
LAWRENCE IN
46226-9358
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-2161
  • Fax:
Mailing address:
  • Phone: 317-755-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5783
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5783
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01066052A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: