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General NPI Number Information
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NPI Number | 1679579577
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Entity Type | Individual
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Provider Name | MICHAEL LEE STARK DO
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 1118 FAIRINGTON DR
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City | SIDNEY
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State | OH
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Zip | 45365-8913
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Country | US
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Telephone | 937-492-3755
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Fax | 937-492-1132
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Provider Business Mailing Address
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Address Line | 4445 LAKE FOREST DR STE 600
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City | BLUE ASH
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State | OH
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Zip | 45242-3744
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Country | US
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Telephone | 513-569-3741
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Fax | 937-492-1132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 3380
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License Number State | OH
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