Healthcare Provider Details

I. General information

NPI: 1184777823
Provider Name (Legal Business Name): JUSTICE MED-LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 W 81ST ST
JUSTICE IL
60458-1350
US

IV. Provider business mailing address

9050 W 81ST ST
JUSTICE IL
60458-1350
US

V. Phone/Fax

Practice location:
  • Phone: 708-594-3500
  • Fax: 708-563-0916
Mailing address:
  • Phone: 708-594-3500
  • Fax: 708-563-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE CHRISTOU
Title or Position: MANAGER
Credential: M.D.
Phone: 708-563-0330