Provider Demographics
NPI:1134319387
Name:TINA STARKWEATHER DPM & ASSOCIATES PC
Entity Type:Organization
Organization Name:TINA STARKWEATHER DPM & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STARKWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-899-3338
Mailing Address - Street 1:2560 HAUSER ROSS DR.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178
Mailing Address - Country:US
Mailing Address - Phone:815-899-3338
Mailing Address - Fax:815-899-3332
Practice Address - Street 1:2560 HAUSER ROSS DR.
Practice Address - Street 2:SUITE 400
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-899-3338
Practice Address - Fax:815-899-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.004861213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1289950001Medicare NSC
IL6132020001Medicare NSC
IL6132020002Medicare NSC
IL215516Medicare PIN