Provider Demographics
NPI:1376701805
Name:STARSURGICAL
Entity Type:Organization
Organization Name:STARSURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINO
Authorized Official - Suffix:
Authorized Official - Credentials:RCSA
Authorized Official - Phone:630-330-1761
Mailing Address - Street 1:PO BOX 88543
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-0543
Mailing Address - Country:US
Mailing Address - Phone:630-330-1761
Mailing Address - Fax:630-762-9681
Practice Address - Street 1:2373 WHITE ROSE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5140
Practice Address - Country:US
Practice Address - Phone:630-330-1761
Practice Address - Fax:630-762-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000022208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1407882210OtherNPI FOR PROVIDER JOSE ESPINO
IL04732058OtherBC PROVIDER NUMBER
IL1891095196OtherNPI FOR MARIA KONIECZKO