Provider Demographics
NPI:1629592225
Name:STARLING, JUSTIN WILLIAM
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:WILLIAM
Last Name:STARLING
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 1:1515 KEYS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2933
Mailing Address - Country:US
Mailing Address - Phone:217-816-1606
Mailing Address - Fax:
Practice Address - Street 1:1515 KEYS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2933
Practice Address - Country:US
Practice Address - Phone:217-816-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical