Healthcare Provider Details

I. General information

NPI: 1912541467
Provider Name (Legal Business Name): STARSIAK OSTEOPATHIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 EAGLE CREEK PKWY STE A
INDIANAPOLIS IN
46254-4692
US

IV. Provider business mailing address

3145 SUMMERFIELD DR
INDIANAPOLIS IN
46214-1875
US

V. Phone/Fax

Practice location:
  • Phone: 317-410-9978
  • Fax:
Mailing address:
  • Phone: 317-410-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DAVID STARSIAK
Title or Position: CEO
Credential: DO
Phone: 317-410-9978