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General NPI Number Information
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NPI Number | 1255092250
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Entity Type | Organization
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Legal Business Name | PPG LABS LLC
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 33 W ROOSEVELT RD STE H
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City | LOMBARD
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State | IL
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Zip | 60148-4401
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Country | US
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Telephone | 847-269-0749
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Fax |
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Provider Business Mailing Address
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Address Line | 33 W ROOSEVELT RD STE H
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City | LOMBARD
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State | IL
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Zip | 60148-4401
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Country | US
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Telephone | 844-774-5227
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | KHALED ALTAWAFSHAH
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Credential |
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Telephone | 630-921-1078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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