Healthcare Provider Details

I. General information

NPI: 1922706928
Provider Name (Legal Business Name): LTE PREVENTIVE HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W 103RD ST
CHICAGO IL
60628-2403
US

IV. Provider business mailing address

9836 S HOXIE AVE
CHICAGO IL
60617-5322
US

V. Phone/Fax

Practice location:
  • Phone: 855-357-2683
  • Fax:
Mailing address:
  • Phone: 708-351-9113
  • 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: DR. CRAIG FLOWERS
Title or Position: CEO
Credential: MD
Phone: 708-351-9113