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General NPI Number Information
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NPI Number | 1316896053
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Entity Type | Organization
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Legal Business Name | STARDOC MEDICAL LLC
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 15525 S PARK AVE STE 103A
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-1379
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Country | US
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Telephone | 708-466-9351
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Fax | 708-816-5569
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Provider Business Mailing Address
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Address Line | 15525 S PARK AVE STE 103A
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-1379
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Country | US
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Telephone | 708-466-9351
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Fax | 708-816-5569
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Authorized Official
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Title or Position | PRESIDENT
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Name | FOLARIN OPAKUNLE
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Credential | DNPN DOCTOR
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Telephone | 708-466-9351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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