John Gregory Stark, MD

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

23369 Issued in MN

Practice address

825 Nicollet Mall
Suite 715
Minneapolis, MN 55402-2595

Phone

(612) 332-2324

Fax

(612) 332-1019

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1306816996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL",
            "address_2": "SUITE 715",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022606",
            "telephone_number": "612-332-2324",
            "fax_number": "612-332-1019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL",
            "address_2": "SUITE 715",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022595",
            "telephone_number": "612-332-2324",
            "fax_number": "612-332-1019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "JOHN",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "MN",
            "license": "23369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126002200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP/MEDICA",
            "identifier": "09-01240",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA MEDICAL LICENSE",
            "identifier": "23369",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Constantin N Starchook, MD
• Nancy Stark Opsahl
• Amie Stark, RN
• Amy Stark, D.D.S
• Jenna Stark
• Matthew Jon Stark, DDS
• Molly Marie Stark, DPT
• Monica Dorothy Stark, PT, DPT
• Patricia A Stark, PH.D., LP
• Randall P Stark, M.D.

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.