Healthcare Provider Details

I. General information

NPI: 1902416936
Provider Name (Legal Business Name): CHICAGO LAB SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7422 N WESTERN AVE STE 1
CHICAGO IL
60645-1707
US

IV. Provider business mailing address

7422 N WESTERN AVE STE 1
CHICAGO IL
60645-1707
US

V. Phone/Fax

Practice location:
  • Phone: 773-274-3418
  • Fax: 773-856-6829
Mailing address:
  • Phone: 773-274-3418
  • Fax: 773-856-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAISTA HABIB
Title or Position: PRESIDENT
Credential: M.S
Phone: 630-788-0870