Provider Demographics
NPI:1720719537
Name:CONNER, STARSKY
Entity Type:Individual
Prefix:
First Name:STARSKY
Middle Name:
Last Name:CONNER
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 1:375 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-6611
Mailing Address - Country:US
Mailing Address - Phone:708-639-8089
Mailing Address - Fax:
Practice Address - Street 1:375 IRIS LN
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-6611
Practice Address - Country:US
Practice Address - Phone:708-639-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)