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NPI Code Detail

MEDICARE: EZEKIELUS STARR III

MEDICARE: EZEKIELUS STARR III
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianIL

General Provider Information

NPI Number : 1194672717
Entity Type Code : Individual
Provider Name (Legal Business Name) : EZEKIELUS STARR III
Provider Business Mailing Address
First Line : 996 ROYAL MARCO WAY
Second Line :
City : MARCO ISLAND
State : FL
Zip : 34145-1829
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5540 W 111TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-5574
Country : US
Telephone Number : 708-634-0821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ EZEKIELUS STARR III ” Practice Location

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