Provider Demographics
NPI:1316961014
Name:STAR, SARA L (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:L
Last Name:STAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:STAR
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 NORTH WESTMORELAND ROAD #217
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:847-432-8422
Mailing Address - Fax:847-432-9480
Practice Address - Street 1:1160 PARK AVENUE WEST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-432-8422
Practice Address - Fax:847-432-9480
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0908902080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine