Michael J Star

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

01075143A Issued in IN

Practice address

615 N Michigan St
1St FL Hospitalist Ste
South Bend, IN 46601-1033

Phone

(574) 647-3050

Fax

(574) 647-1094

NPI assigned

Apr 4, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Michael J Star Professional name

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": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1417246018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR.",
            "address_2": "SUITE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465303245",
            "telephone_number": "547-647-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "address_2": "1ST FL HOSPITALIST STE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-3050",
            "fax_number": "574-647-1094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAR",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-04",
        "last_updated": "2023-05-01",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01075143A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300055663",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "STAR",
            "middle_name": "J",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ronald Stangebye, DDS
• Cynthia Danielle Stanton
• Catherine Stapleford, MSED
• Star Psychiatric Services PC
• Star Psychiatric Services PC
• Starlight Care Facilities, Inc
• Starline Community Services Inc
• Anthony Starzynski
• Joseph Michael Statz, MD
• Judith Stayback

• Neurology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Neurology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.