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General NPI Number Information
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NPI Number | 1952096950
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Entity Type | Organization
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Legal Business Name | LAKE PARK PODIATRY
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 701 PARK AVE
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City | LAKE PARK
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State | FL
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Zip | 33403-2503
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Country | US
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Telephone | 561-294-6886
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Fax | 561-627-2199
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Provider Business Mailing Address
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Address Line | 701 PARK AVE
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City | LAKE PARK
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State | FL
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Zip | 33403-2503
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Country | US
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Telephone | 561-294-6886
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Fax | 561-627-2199
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. HENRY KAY STARK
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Credential | DPM
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Telephone | 561-284-6886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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