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General NPI Number Information
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NPI Number | 1710360995
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Entity Type | Organization
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Legal Business Name | BRIDGES LLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 2606 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60647-1734
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Country | US
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Telephone | 773-255-2456
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Fax |
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Provider Business Mailing Address
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Address Line | 2606 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60647-1734
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Country | US
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Telephone | 773-255-2456
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Fax |
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | MR. ANDREW MIGDAL
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Credential | CLIA ID: 14D2091522
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Telephone | 773-255-2456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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