Healthcare Provider Details

I. General information

NPI: 1659370047
Provider Name (Legal Business Name): CMS LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 SKOKIE BLVD
NORTHBROOK IL
60062-4106
US

IV. Provider business mailing address

1818 SKOKIE BLVD
NORTHBROOK IL
60062-4106
US

V. Phone/Fax

Practice location:
  • Phone: 847-656-0194
  • Fax: 847-714-1615
Mailing address:
  • Phone: 847-656-0194
  • Fax: 847-714-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number10D1044289
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number14D1106803
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number14D0950557
License Number StateIL

VIII. Authorized Official

Name: MR. JAMAL ALWATTAR
Title or Position: PRESIDENT
Credential: M.S.
Phone: 847-480-4680