Healthcare Provider Details

I. General information

NPI: 1982761268
Provider Name (Legal Business Name): STARLIGHT MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 05/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 HOLIAN DR SUITE D
SPRING GROVE IL
60081-7934
US

IV. Provider business mailing address

100 S ATKINSON RD SUITE 169
GRAYSLAKE IL
60030-7817
US

V. Phone/Fax

Practice location:
  • Phone: 815-550-3354
  • Fax: 815-550-3355
Mailing address:
  • Phone: 815-550-3354
  • Fax: 815-550-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203000796
License Number StateIL

VIII. Authorized Official

Name: MS. SUSAN R BERSIE
Title or Position: CEO
Credential:
Phone: 815-550-3354