Healthcare Provider Details

I. General information

NPI: 1316691447
Provider Name (Legal Business Name): APPLIED LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25553 W WOLFS CROSSING RD UNIT GH
PLAINFIELD IL
60585-6807
US

IV. Provider business mailing address

25553 W WOLFS CROSSING RD UNIT GH
PLAINFIELD IL
60585-6807
US

V. Phone/Fax

Practice location:
  • Phone: 630-841-2043
  • Fax: 630-893-1400
Mailing address:
  • Phone: 630-841-2043
  • Fax: 630-893-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PARVEEN BAKHTIARI
Title or Position: MANAGER
Credential:
Phone: 630-841-2043