Healthcare Provider Details

I. General information

NPI: 1902803554
Provider Name (Legal Business Name): THERATEST LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N MAIN ST
LOMBARD IL
60148-1360
US

IV. Provider business mailing address

1111 N MAIN ST
LOMBARD IL
60148-1360
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-6069
  • Fax: 630-627-4231
Mailing address:
  • Phone: 630-627-6069
  • Fax: 630-627-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number2087-8990 TLV
License Number StateIL

VIII. Authorized Official

Name: DR. MARIUS TEODORESCU
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 630-627-6069