Provider Demographics
NPI:1285605683
Name:STARKWEATHER, TINA L (DPM)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:L
Last Name:STARKWEATHER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4336
Mailing Address - Country:US
Mailing Address - Phone:515-330-9018
Mailing Address - Fax:515-330-3439
Practice Address - Street 1:2733 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-330-9018
Practice Address - Fax:515-330-3439
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.004861213ES0103X
IA00661213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215516Medicare PIN
U73899Medicare UPIN
IL1289950001Medicare NSC
IL533780Medicare ID - Type Unspecified
ILK41454Medicare PIN