Healthcare Provider Details

I. General information

NPI: 1083375893
Provider Name (Legal Business Name): TBF DIAGNOSTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 CRAWFORD AVE # L1
SKOKIE IL
60076-1700
US

IV. Provider business mailing address

2916 CENTRAL ST # 2A
EVANSTON IL
60201-1212
US

V. Phone/Fax

Practice location:
  • Phone: 224-999-7624
  • Fax:
Mailing address:
  • Phone: 224-999-7624
  • Fax: 847-589-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TAKALA FOMOND
Title or Position: OWNER
Credential:
Phone: 224-420-6894