Provider Demographics
NPI:1093211518
Name:STARLAB DIAGNOSTICS INC
Entity Type:Organization
Organization Name:STARLAB DIAGNOSTICS INC
Other - Org Name:STARLAB DIAGNOSTICS INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATELONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-802-2288
Mailing Address - Street 1:9213 PARKLANE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9213 PARKLANE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2837
Practice Address - Country:US
Practice Address - Phone:847-802-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MobileGroup - Single Specialty