Healthcare Provider Details

I. General information

NPI: 1154082071
Provider Name (Legal Business Name): IDRIVIO LLC DBA TEAMFICIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 N WESTERN AVE
CHICAGO IL
60647-6531
US

IV. Provider business mailing address

2058 N WESTERN AVE
CHICAGO IL
60647-6531
US

V. Phone/Fax

Practice location:
  • Phone: 217-279-1400
  • Fax:
Mailing address:
  • Phone: 773-828-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: SAMAD KHAN
Title or Position: LAB DIRECTOR
Credential:
Phone: 847-361-9333