Provider Demographics
NPI:1073917969
Name:CITY LAB INC
Entity Type:Organization
Organization Name:CITY LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAMS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-324-9132
Mailing Address - Street 1:3415 HOWARD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-4011
Mailing Address - Country:US
Mailing Address - Phone:847-324-9132
Mailing Address - Fax:847-324-9134
Practice Address - Street 1:3415 HOWARD ST STE 102
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-4011
Practice Address - Country:US
Practice Address - Phone:847-324-9132
Practice Address - Fax:847-324-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D2083891291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory