MEDICARE: LUCID LABS HEALTH LLC

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

General Provider Information

NPI Number	:	1225749856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCID LABS HEALTH LLC

Provider Business Mailing Address
First Line	:	2320 W PETERSON AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-5244
Country	:	US
Telephone Number	:	773-531-0206
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 W PETERSON AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-5244
Country	:	US
Telephone Number	:	773-531-0206
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. ABDUL GAFFAR ZAINULABDEEN
Credential	:
Telephone Number	:	773-531-0206

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/16/2025

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