Healthcare Provider Details

I. General information

NPI: 1619299559
Provider Name (Legal Business Name): STARK PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 TUSCARAWAS ST W SUITE 300
CANTON OH
44708-4197
US

IV. Provider business mailing address

3030 TUSCARAWAS ST W SUITE 300
CANTON OH
44708-4197
US

V. Phone/Fax

Practice location:
  • Phone: 330-452-6109
  • Fax: 330-452-5060
Mailing address:
  • Phone: 330-452-6109
  • Fax: 330-452-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35076415Y
License Number StateOH

VIII. Authorized Official

Name: DR. ASIF YOUNUS
Title or Position: PRESIDENT
Credential: MD
Phone: 330-452-6109