MEDICARE: DR. CATHERINE M STARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301063537	MI

General Provider Information

NPI Number	:	1659352730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE M STARK MD

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	STE 200
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	248-997-5805
Fax Number	:	248-997-5811

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E
Second Line	:	STE 200
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	248-997-5805
Fax Number	:	248-997-5811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/17/2012

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