MEDICARE: SH DIAGNOSTICS 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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14D2263216	OTHER	IL	CLIA

General Provider Information

NPI Number	:	1124753249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SH DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	3525 W PETERSON AVE STE 117
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3313
Country	:	US
Telephone Number	:	312-722-6925
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 W PETERSON AVE STE 117
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3313
Country	:	US
Telephone Number	:	312-722-6925
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAFIUDDIN SULTANI
Credential	:
Telephone Number	:	312-722-6925

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	12/15/2023

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Directions to “SH DIAGNOSTICS INC ” Practice Location

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