MEDICARE: STARLIGHT MEDICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	203000796	IL

General Provider Information

NPI Number	:	1982761268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLIGHT MEDICAL INC

Provider Business Mailing Address
First Line	:	100 S ATKINSON RD
Second Line	:	SUITE 169
City	:	GRAYSLAKE
State	:	IL
Zip	:	60030-7817
Country	:	US
Telephone Number	:	815-550-3354
Fax Number	:	815-550-3355

Provider Business Practice Location Address
First Line	:	1803 HOLIAN DR
Second Line	:	SUITE D
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-7934
Country	:	US
Telephone Number	:	815-550-3354
Fax Number	:	815-550-3355

Authorized Official
Title or Position	:	CEO
Name	:	MS. SUSAN R BERSIE
Credential	:
Telephone Number	:	815-550-3354

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	05/18/2008

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Directions to “STARLIGHT MEDICAL INC ” Practice Location

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