Provider Demographics
NPI:1487773206
Name:STARLING, JOHN III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:STARLING
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-683-5278
Mailing Address - Fax:920-686-9674
Practice Address - Street 1:2600 N MAYFAIR RD STE 810
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1328
Practice Address - Country:US
Practice Address - Phone:414-771-1122
Practice Address - Fax:414-771-1352
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54120-020207ND0101X, 207N00000X, 207ND0101X
OH35.093355207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487773206Medicaid
WIFS1344960OtherDEA
WI54120-020OtherSTATE OF WISCONSIN MEDICAL LICENSE
WIFS1344960OtherDEA
OH35.093355OtherSTATE OF OHIO MEDICAL LICENSE
WI1487773206Medicaid
WIFS1344960OtherDEA