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General NPI Number Information
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NPI Number | 1588326326
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Entity Type | Organization
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Legal Business Name | CRYSTAL LAB WORKS LLC
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 4850 MAIN ST
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City | SKOKIE
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State | IL
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Zip | 60077-2512
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Country | US
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Telephone | 847-372-5920
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 MAIN ST
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City | SKOKIE
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State | IL
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Zip | 60077-2512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. RAJ PILLAI
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Credential |
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Telephone | 312-493-9749
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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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