Provider Demographics
NPI:1699744961
Name:STARK, KARL R (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:R
Last Name:STARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KARL
Other - Middle Name:R
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2750 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3237
Mailing Address - Country:US
Mailing Address - Phone:816-842-5555
Mailing Address - Fax:816-842-8888
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 304
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-842-5555
Practice Address - Fax:816-842-8888
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8A78174400000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC51308Medicare UPIN