Provider Demographics
NPI:1043689706
Name:STARCK, LUKAS
Entity Type:Individual
Prefix:
First Name:LUKAS
Middle Name:
Last Name:STARCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E RAILROAD AVE UNIT 209
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4486
Mailing Address - Country:US
Mailing Address - Phone:414-416-1331
Mailing Address - Fax:
Practice Address - Street 1:275 E RAILROAD AVE UNIT 209
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4486
Practice Address - Country:US
Practice Address - Phone:414-416-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56009942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist