MEDICARE: PETR STAROSTIK 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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	225348	NY
2	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	ME121219	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720069594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETR STAROSTIK MD

Provider Business Mailing Address
First Line	:	1600 SW ARCHER RD BOX 100275
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0275
Country	:	US
Telephone Number	:	352-273-7842
Fax Number	:	352-273-8172

Provider Business Practice Location Address
First Line	:	1600 SW ARCHER RD BOX 100275
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0001
Country	:	US
Telephone Number	:	352-273-7842
Fax Number	:	352-273-8172

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	11/22/2017

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Directions to “ PETR STAROSTIK MD” Practice Location

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