MEDICARE: METROMED LABORATORIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0050000002	OTHER	IL	BLUE CROSS BLUE SHIELD NO

General Provider Information

NPI Number	:	1417070095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROMED LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	5330 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1637
Country	:	US
Telephone Number	:	773-725-5454
Fax Number	:

Authorized Official
Title or Position	:	SYSTEM MANAGER
Name	:	MR. ALEX SUMYK
Credential	:
Telephone Number	:	773-725-5454

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/21/2022

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