Provider Demographics
NPI:1356006407
Name:US SPA CORP
Entity Type:Organization
Organization Name:US SPA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZOHAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-498-1738
Mailing Address - Street 1:2760 S HIGHLAND AVE APT 525
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5435
Mailing Address - Country:US
Mailing Address - Phone:312-498-1738
Mailing Address - Fax:
Practice Address - Street 1:920 N RIDGE AVE STE A4
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1226
Practice Address - Country:US
Practice Address - Phone:312-498-1738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory