Basic Information
| Provider Information | |||||||||
| NPI: | 1588002661 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TRIEMSTRA | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 HARVESTER DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605277594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737021000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 180 N HARVESTER DRIVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737021000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2013 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | 036.140257 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
No ID Information.