Provider Demographics
NPI:1417070095
Name:METROMED LABORATORIES, INC.
Entity Type:Organization
Organization Name:METROMED LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-725-5454
Mailing Address - Street 1:5330 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5330 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1637
Practice Address - Country:US
Practice Address - Phone:773-725-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0050000002OtherBLUE CROSS BLUE SHIELD NO
IL0050000002OtherBLUE CROSS BLUE SHIELD NO
IL148136Medicare ID - Type Unspecified