MEDICARE: BIOLUMINUX CLINICAL RESEARCH ILLINOIS

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	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1598586489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOLUMINUX CLINICAL RESEARCH ILLINOIS

Provider Business Mailing Address
First Line	:	7S560 DONWOOD DR E
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-9555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 BROM CT STE 205
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6534
Country	:	US
Telephone Number	:	331-401-5117
Fax Number	:	331-401-5024

Authorized Official
Title or Position	:	CEO
Name	:	DR. ADEWALE LAWRENCE
Credential	:	MD
Telephone Number	:	331-814-9593

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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