Healthcare Provider Details

I. General information

NPI: 1508708306
Provider Name (Legal Business Name): CLEARLINE DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 LEE ST
DES PLAINES IL
60016-6532
US

IV. Provider business mailing address

950 LEE ST STE 103
DES PLAINES IL
60016-6556
US

V. Phone/Fax

Practice location:
  • Phone: 312-809-1399
  • Fax:
Mailing address:
  • Phone: 312-809-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA IBEH
Title or Position: MANAGER
Credential:
Phone: 480-249-6100