Provider Demographics
NPI:1104269216
Name:STARKS MD LLC
Entity type:Organization
Organization Name:STARKS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-452-4822
Mailing Address - Street 1:607 OLD STEESE HWY
Mailing Address - Street 2:STE B314 PMB#
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3131
Mailing Address - Country:US
Mailing Address - Phone:907-452-4822
Mailing Address - Fax:907-452-4824
Practice Address - Street 1:1919 LATHROP ST
Practice Address - Street 2:STE 204
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5937
Practice Address - Country:US
Practice Address - Phone:907-452-4822
Practice Address - Fax:907-452-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty