Provider Demographics
NPI:1154082071
Name:IDRIVIO LLC DBA TEAMFICIENT
Entity Type:Organization
Organization Name:IDRIVIO LLC DBA TEAMFICIENT
Other - Org Name:TEAMFICIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-361-9333
Mailing Address - Street 1:2058 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6531
Mailing Address - Country:US
Mailing Address - Phone:773-828-6480
Mailing Address - Fax:
Practice Address - Street 1:2058 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6531
Practice Address - Country:US
Practice Address - Phone:217-279-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No305S00000XManaged Care OrganizationsPoint of Service