Provider Demographics
NPI:1235566753
Name:K G A PHLEBOTOMIST, INC
Entity Type:Organization
Organization Name:K G A PHLEBOTOMIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-616-2906
Mailing Address - Street 1:10714 S ROBERTS RD STE C
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2314
Mailing Address - Country:US
Mailing Address - Phone:815-616-2906
Mailing Address - Fax:
Practice Address - Street 1:10714 S ROBERTS RD STE C
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2314
Practice Address - Country:US
Practice Address - Phone:815-616-2906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-29
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory