Healthcare Provider Details

I. General information

NPI: 1184379422
Provider Name (Legal Business Name): ZOOM LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 W PETERSON AVE STE 108
CHICAGO IL
60659-3919
US

IV. Provider business mailing address

2721 W PETERSON AVE STE 108
CHICAGO IL
60659-3919
US

V. Phone/Fax

Practice location:
  • Phone: 773-829-1007
  • Fax:
Mailing address:
  • Phone: 773-829-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ARIF ISMAILBHAI PATEL
Title or Position: OWNER
Credential:
Phone: 773-829-1007