Provider Demographics
NPI:1407189731
Name:STARRETT MEDICAL ASSOCIATES SC
Entity Type:Organization
Organization Name:STARRETT MEDICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:STARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-892-7629
Mailing Address - Street 1:1300 N HIGHLAND AVE
Mailing Address - Street 2:STE. 10
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1451
Mailing Address - Country:US
Mailing Address - Phone:630-892-7629
Mailing Address - Fax:630-892-7690
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:STE. 10
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-892-7629
Practice Address - Fax:630-892-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38173Medicare UPIN