Healthcare Provider Details

I. General information

NPI: 1306771670
Provider Name (Legal Business Name): TRIDENT CLINICAL LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 WARRENVILLE RD STE 273
LISLE IL
60532-1000
US

IV. Provider business mailing address

3030 WARRENVILLE RD STE 273
LISLE IL
60532-1000
US

V. Phone/Fax

Practice location:
  • Phone: 317-891-4501
  • Fax: 312-395-7290
Mailing address:
  • Phone: 317-891-4501
  • Fax: 312-395-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ASIYA BEGUM
Title or Position: OWNER
Credential:
Phone: 317-891-4501