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General NPI Number Information
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NPI Number | 1083375893
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Entity Type | Organization
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Legal Business Name | TBF DIAGNOSTIC INC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 9150 CRAWFORD AVE # L1
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City | SKOKIE
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State | IL
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Zip | 60076-1700
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Country | US
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Telephone | 224-999-7624
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Fax |
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Provider Business Mailing Address
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Address Line | 2916 CENTRAL ST # 2A
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City | EVANSTON
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State | IL
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Zip | 60201-1212
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Country | US
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Telephone | 224-999-7624
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Fax | 847-589-5944
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Authorized Official
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Title or Position | OWNER
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Name | TAKALA FOMOND
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Credential |
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Telephone | 224-420-6894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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