Healthcare Provider Details

I. General information

NPI: 1497577027
Provider Name (Legal Business Name): CIMPAR CLINICAL LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W NORTH AVE
MELROSE PARK IL
60160-1603
US

IV. Provider business mailing address

501 W NORTH AVE
MELROSE PARK IL
60160-1603
US

V. Phone/Fax

Practice location:
  • Phone: 773-415-4030
  • Fax: 708-486-2702
Mailing address:
  • Phone: 773-415-4030
  • Fax: 708-486-2702

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: DAN ROMAN
Title or Position: CFO
Credential:
Phone: 773-415-4030