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General NPI Number Information
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NPI Number | 1366184004
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Entity Type | Organization
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Legal Business Name | CHILABORATORYLLC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 817 W LINCOLN HWY STE A
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City | DEKALB
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State | IL
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Zip | 60115-3002
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Country | US
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Telephone | 773-344-5018
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Fax |
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Provider Business Mailing Address
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Address Line | 9648 KEDVALE AVE
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City | SKOKIE
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State | IL
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Zip | 60076-1120
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Country | US
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Telephone | 773-344-5018
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FNU MOHAMMED FAROOQ ADIL
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Credential |
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Telephone | 773-344-5018
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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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