Healthcare Provider Details

I. General information

NPI: 1588324958
Provider Name (Legal Business Name): COVID SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 W NORTH AVE STE 110
WEST CHICAGO IL
60185-6239
US

IV. Provider business mailing address

4303 ROYAL FOX DR
SAINT CHARLES IL
60174-8785
US

V. Phone/Fax

Practice location:
  • Phone: 630-398-6504
  • Fax:
Mailing address:
  • Phone: 630-456-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. MILAN D MITIC
Title or Position: MEMBER
Credential:
Phone: 630-456-1658