Healthcare Provider Details

I. General information

NPI: 1093211518
Provider Name (Legal Business Name): STARLAB DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9213 PARKLANE AVE STE 101
FRANKLIN PARK IL
60131-2837
US

IV. Provider business mailing address

9213 PARKLANE AVE STE 101
FRANKLIN PARK IL
60131-2837
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-2288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VERMILY PATELONA
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-802-2288