Healthcare Provider Details

I. General information

NPI: 1639985468
Provider Name (Legal Business Name): PRISM HEALTH LAB USA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W GRAND AVE STE 500
CHICAGO IL
60654-6799
US

IV. Provider business mailing address

6505 N LONGMEADOW AVE
LINCOLNWOOD IL
60712-3205
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-1812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ZUL KAPADIA
Title or Position: DIRECTOR/PRESIDENT
Credential:
Phone: 800-325-1812