Healthcare Provider Details

I. General information

NPI: 1598763914
Provider Name (Legal Business Name): NRI LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 N MILWAUKEE AVE
CHICAGO IL
60646-5424
US

IV. Provider business mailing address

5960 N MILWAUKEE AVE
CHICAGO IL
60646-5424
US

V. Phone/Fax

Practice location:
  • Phone: 773-775-6743
  • Fax: 773-775-6673
Mailing address:
  • Phone: 773-775-6743
  • Fax: 773-775-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number14D0646644
License Number StateIL

VIII. Authorized Official

Name: MR. REYNALDO ILAGAN
Title or Position: PRESIDENT
Credential: PRESIDENT
Phone: 773-773-6743