Healthcare Provider Details

I. General information

NPI: 1316896053
Provider Name (Legal Business Name): STARDOC MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 S PARK AVE STE 103A
SOUTH HOLLAND IL
60473-1379
US

IV. Provider business mailing address

15525 S PARK AVE STE 103A
SOUTH HOLLAND IL
60473-1379
US

V. Phone/Fax

Practice location:
  • Phone: 708-466-9351
  • Fax: 708-816-5569
Mailing address:
  • Phone: 708-466-9351
  • Fax: 708-816-5569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: FOLARIN OPAKUNLE
Title or Position: PRESIDENT
Credential: DNPN DOCTOR
Phone: 708-466-9351