Healthcare Provider Details

I. General information

NPI: 1972258192
Provider Name (Legal Business Name): GC LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 N SHERIDAN RD
CHICAGO IL
60640-3118
US

IV. Provider business mailing address

5012 N SHERIDAN RD
CHICAGO IL
60640-3118
US

V. Phone/Fax

Practice location:
  • Phone: 312-927-7860
  • Fax:
Mailing address:
  • Phone: 312-927-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MUJEEB U KHAJA
Title or Position: OWNER
Credential: BSC
Phone: 312-927-7860