Healthcare Provider Details

I. General information

NPI: 1528807351
Provider Name (Legal Business Name): LEMEDIX LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 ROOSEVELT RD STE 6-104
GLEN ELLYN IL
60137-5910
US

IV. Provider business mailing address

799 ROOSEVELT RD STE 6-104
GLEN ELLYN IL
60137-5910
US

V. Phone/Fax

Practice location:
  • Phone: 630-201-4786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAIHAAN KHAN
Title or Position: OFFICER
Credential:
Phone: 630-201-4786