Basic Information
| Provider Information | |||||||||
| NPI: | 1396724498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STARKEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1633 MEDICAL CENTER POINT | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809071604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196674139 | ||||||||
| FaxNumber: | 7194738843 | ||||||||
| Practice Location | |||||||||
| Address1: | 1633 MEDICAL CENTER POINT | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809071604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196674139 | ||||||||
| FaxNumber: | 7194738843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 5370 | AK | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 025254 | LA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 33681 | AZ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 44778 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 5370 | 01 | AK | ALASKA STATE LICENSE | OTHER | 00398789 | 01 | RADSOCNORTHAMERICA MEM # | OTHER | 33681 | 01 | AZ | ARIZONA STATE LICENSE | OTHER | BS7237539 | 01 | DEA NUMBER | OTHER | 025254 | 01 | LA | LOUISIANA STATE BOARD LIC | OTHER | 12756041 | 05 | CO | MEDICAID |