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General NPI Number Information
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NPI Number | 1538669510
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Entity Type | Organization
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Legal Business Name | OA LABS CLINIC LLC.
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6321 FAIRVIEW AVE STE B
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City | WESTMONT
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State | IL
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Zip | 60559-2886
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Country | US
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Telephone | 630-235-0220
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Fax | 985-370-2321
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Provider Business Mailing Address
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Address Line | 6321 FAIRVIEW AVE STE B
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City | WESTMONT
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State | IL
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Zip | 60559-2886
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Country | US
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Telephone | 630-235-0220
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Fax | 985-370-2321
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Authorized Official
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Title or Position | DIRECTOR OF MEDICINE
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Name | DR. NICHOLAS MATARAGAS
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Credential | MD
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Telephone | 630-235-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 336070137
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License Number State | IL
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