Healthcare Provider Details

I. General information

NPI: 1558440768
Provider Name (Legal Business Name): SNAP LABORATORIES INTERNATIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 CAPITOL DR
WHEELING IL
60090-7901
US

IV. Provider business mailing address

5210 CAPITOL DR
WHEELING IL
60090-7901
US

V. Phone/Fax

Practice location:
  • Phone: 847-777-0000
  • Fax: 847-465-3404
Mailing address:
  • Phone: 847-777-0000
  • Fax: 847-465-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberWR000335
License Number StateIL

VIII. Authorized Official

Name: DR. GIL RAVIV
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 847-777-0000