Healthcare Provider Details

I. General information

NPI: 1053896928
Provider Name (Legal Business Name): HEALING PRO LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E RAND RD
ARLINGTON HEIGHTS IL
60004-4366
US

IV. Provider business mailing address

1925 E RAND RD
ARLINGTON HEIGHTS IL
60004-4366
US

V. Phone/Fax

Practice location:
  • Phone: 224-735-3522
  • Fax: 224-735-3523
Mailing address:
  • Phone: 224-735-3522
  • Fax: 224-735-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RANA SAIFAN
Title or Position: ADMINISTRATOR
Credential: PHLEBOTOMIST
Phone: 312-945-9402