Provider Demographics
NPI:1477205292
Name:K52 LLC
Entity Type:Organization
Organization Name:K52 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-532-1885
Mailing Address - Street 1:1815 E CAMP MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1723
Mailing Address - Country:US
Mailing Address - Phone:312-730-7860
Mailing Address - Fax:
Practice Address - Street 1:4325 N JESTERS CT
Practice Address - Street 2:STE 9
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:312-532-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-23
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center