Healthcare Provider Details

I. General information

NPI: 1144816356
Provider Name (Legal Business Name): STEVEN ABU SHAQRA DOCTOR, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 05/13/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH CHICAGO LAB SUITE # 5 8058 S. WESTERN AVE
CHICAGO IL
60620-2402
US

IV. Provider business mailing address

10215 S 84TH AVE
PALOS HILLS IL
60465-1302
US

V. Phone/Fax

Practice location:
  • Phone: 815-440-9285
  • Fax:
Mailing address:
  • Phone: 815-440-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: