Healthcare Provider Details

I. General information

NPI: 1417380106
Provider Name (Legal Business Name): GABACHIEF MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8343 W LAWRENCE AVE
NORRIDGE IL
60706-3129
US

IV. Provider business mailing address

4916 N CRESCENT AVE
NORRIDGE IL
60706-3108
US

V. Phone/Fax

Practice location:
  • Phone: 708-420-0063
  • Fax:
Mailing address:
  • Phone: 708-420-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203.001595
License Number StateIL

VIII. Authorized Official

Name: BRIAN J COSTELLO
Title or Position: CEO
Credential:
Phone: 708-420-0063