MEDICARE: STAR LAB, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	246QM0706X	Medical Technologist
2	246RM2200X	Medical Laboratory Technician
3	246RP1900X	Phlebotomy Technician
4	347C00000X	Private Vehicle
5	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1720378524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR LAB, INC

Provider Business Mailing Address
First Line	:	255 GARDEN DR
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60124-0230
Country	:	US
Telephone Number	:	847-802-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	9213 PARKLANE AVE
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2837
Country	:	US
Telephone Number	:	847-329-7500
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RICHARD FELICELDA
Credential	:
Telephone Number	:	847-802-2288

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/22/2016

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Directions to “STAR LAB, INC ” Practice Location

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