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NPI Code Detail

MEDICARE: LABPRO INC

MEDICARE: LABPRO 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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114D2015890OTHERILCLIA#
214D2025730OTHERILCLIA#

General Provider Information

NPI Number : 1154624799
Entity Type Code : Organization
Provider Name (Legal Business Name) : LABPRO INC
Provider Business Mailing Address
First Line : 7444 W WILSON AVE STE 103
Second Line :
City : HARWOOD HEIGHTS
State : IL
Zip : 60706-4549
Country : US
Telephone Number : 630-548-7887
Fax Number : 708-831-4253
Provider Business Practice Location Address
First Line : 7444 W WILSON AVE STE 103
Second Line :
City : HARWOOD HEIGHTS
State : IL
Zip : 60706-4549
Country : US
Telephone Number : 630-548-7887
Fax Number : 708-831-4253
Authorized Official
Title or Position : PRESIDENT
Name : ELLIOTT LATINIK
Credential :
Telephone Number : 630-527-6100
Provider Enumeration Date : 12/20/2010
Last Update Date : 09/17/2018

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Directions to “LABPRO INC ” Practice Location

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