Healthcare Provider Details

I. General information

NPI: 1225749856
Provider Name (Legal Business Name): LUCID LABS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 W PETERSON AVE STE 200
CHICAGO IL
60659-5244
US

IV. Provider business mailing address

2320 W PETERSON AVE STE 200
CHICAGO IL
60659-5244
US

V. Phone/Fax

Practice location:
  • Phone: 773-531-0206
  • Fax:
Mailing address:
  • Phone: 773-531-0206
  • 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: MR. ABDUL GAFFAR ZAINULABDEEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 773-531-0206