Healthcare Provider Details

I. General information

NPI: 1932069663
Provider Name (Legal Business Name): BRIGHTPATH LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 S ARCHER AVE UNIT 2
LOCKPORT IL
60441-5806
US

IV. Provider business mailing address

14400 S ARCHER AVE UNIT 2
LOCKPORT IL
60441-5806
US

V. Phone/Fax

Practice location:
  • Phone: 320-577-7824
  • Fax:
Mailing address:
  • Phone: 320-577-7824
  • 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: SAIKUMAR PULIMAMIDI
Title or Position: CEO
Credential:
Phone: 320-577-7824