MEDICARE: JULIE MARIA 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	207Q00000X	Family Medicine Physician	036121864	IL
2	207Q00000X	Family Medicine Physician	01073161A	IN

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

General Provider Information

NPI Number	:	1902018641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MARIA STARK MD

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 E WASHINGTON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-3210
Country	:	US
Telephone Number	:	260-209-7111
Fax Number	:	260-222-2835

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/19/2024

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