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General NPI Number Information
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NPI Number | 1851660864
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Entity Type | Organization
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Legal Business Name | NORTHSHORE OSTEOPATHIC HEALTHCARE
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 1029 W PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2550
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Country | US
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Telephone | 847-362-1367
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 W PARK AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-2550
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Country | US
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Telephone | 847-362-1367
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD PHYSICIAN
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Name | DR. JOSEPH STARKMAN
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Credential | D.O.
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Telephone | 847-362-1367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.128002
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License Number State | IL
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