Amanda Marie Stark, D.O.
Family Medicine in Cadillac, MI. Individual provider (NPI-1).
NPI number1164097416
StatusActive
Last updated in NPPESAug 15, 2024
Details
- NPI
- 1164097416
- Entity type
- Individual (NPI-1)
- Name
- Amanda Marie Stark
- Credential
- D.O.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 20, 2021
- Certification date
- Aug 15, 2024
- Last updated
- Aug 15, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 5151014776 | MI | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
8950 Professional DrCadillac, MI 49601-8599
Phone 231-775-2493 · Fax 231-779-7701
Mailing address
Munson Family Practice Center1400 Medical Campus Drive
Traverse City, MI 49684
Phone 231-935-8012 · Fax 231-935-8098
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