Stark, Carol K
Stark, Carol K is an individual health care provider with primary practice located at 4786 Banning Ave , White Bear Lake MN 55110-3264. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Stark, Carol K can be contacted via phone (651) 426-6402.Contact Information
Primary practice address
4786 Banning Ave
White Bear Lake MN 55110-3264
Phone: (651) 426-6402
Fax: (651) 429-3402
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 31736 | Minnesota |
Profile Details
| NPI number | 1063428746 |
|---|---|
| LBN Legal business name | Stark, Carol K |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 1st, 2006 |
| Last updated | Oct 14th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063428746 | NPPES |
| Minnesota | MEDICAID | 190592900 |
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