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General NPI Number Information
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NPI Number | 1528715919
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND TESTING LLC
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 837S WESTMORE MEYERS RD
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City | LOMBARD
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State | IL
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Zip | 60148-3723
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Country | US
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Telephone | 773-733-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 180 N WACKER DR STE 301
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City | CHICAGO
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State | IL
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Zip | 60606-1620
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Country | US
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Telephone | 773-908-3803
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON ST JOHN
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Credential |
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Telephone | 773-908-3803
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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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