Healthcare Provider Details

I. General information

NPI: 1255092250
Provider Name (Legal Business Name): PPG LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W ROOSEVELT RD STE H
LOMBARD IL
60148-4401
US

IV. Provider business mailing address

33 W ROOSEVELT RD STE H
LOMBARD IL
60148-4401
US

V. Phone/Fax

Practice location:
  • Phone: 847-269-0749
  • Fax:
Mailing address:
  • Phone: 844-774-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KHALED ALTAWAFSHAH
Title or Position: CEO/OWNER
Credential:
Phone: 630-921-1078