Provider Demographics
NPI:1992941124
Name:TINA STARKWEATHER DPM & ASSOCAITES, PC
Entity type:Organization
Organization Name:TINA STARKWEATHER DPM & ASSOCAITES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TOLZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-899-3338
Mailing Address - Street 1:2560 HAUSER ROSS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3150
Mailing Address - Country:US
Mailing Address - Phone:815-899-3338
Mailing Address - Fax:815-899-3332
Practice Address - Street 1:2560 HAUSER ROSS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3150
Practice Address - Country:US
Practice Address - Phone:815-899-3338
Practice Address - Fax:815-899-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.004861213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1289950001Medicare NSC