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General NPI Number Information
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NPI Number | 1922706928
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Entity Type | Organization
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Legal Business Name | LTE PREVENTIVE HEALTH SYSTEMS, INC.
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 559 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60628-2403
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Country | US
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Telephone | 855-357-2683
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Fax |
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Provider Business Mailing Address
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Address Line | 9836 S HOXIE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-5322
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Country | US
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Telephone | 708-351-9113
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CRAIG FLOWERS
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Credential | MD
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Telephone | 708-351-9113
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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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