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NPI Code Detail

MEDICARE: JEFFREY S STARON MD

MEDICARE: JEFFREY S STARON MD
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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician036139164IL
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician01066936AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11669472270OTHERINNPI GROUP NUMBER

General Provider Information

NPI Number : 1780723122
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY S STARON MD
Provider Business Mailing Address
First Line : 8141 CALUMET AVE UNIT 1
Second Line :
City : MUNSTER
State : IN
Zip : 46321-1701
Country : US
Telephone Number : 219-961-9480
Fax Number : 630-718-6057
Provider Business Practice Location Address
First Line : 8141 CALUMET AVE UNIT 1
Second Line :
City : MUNSTER
State : IN
Zip : 46321-1701
Country : US
Telephone Number : 219-961-9480
Fax Number : 630-718-6057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 01/04/2019

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Directions to “ JEFFREY S STARON MD” Practice Location

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