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General NPI Number Information
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NPI Number | 1780453712
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Entity Type | Organization
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Legal Business Name | CARDINAL LABS LLC
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 6 E MONROE ST APT 500
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City | CHICAGO
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State | IL
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Zip | 60603-2741
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Country | US
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Telephone | 630-349-0180
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Fax |
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Provider Business Mailing Address
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Address Line | 6 E MONROE ST APT 500
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City | CHICAGO
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State | IL
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Zip | 60603-2741
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Country | US
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Telephone | 630-349-0180
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES JOHNSON
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Credential |
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Telephone | 312-502-0890
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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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