Provider Demographics
NPI:1477671345
Name:NORTHSHORE CLINICAL LABORATORIES INC
Entity Type:Organization
Organization Name:NORTHSHORE CLINICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-570-6510
Mailing Address - Street 1:4751 N KEDZIE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4420
Mailing Address - Country:US
Mailing Address - Phone:773-570-6510
Mailing Address - Fax:
Practice Address - Street 1:4751 N KEDZIE AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4420
Practice Address - Country:US
Practice Address - Phone:773-570-6510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3580499OtherUHC
IL5847070OtherAETNA
IL0001621417OtherBCBS
IL3580499OtherUHC
IL3580499OtherUHC