Provider Demographics
NPI:1659004992
Name:TESTATIVE
Entity Type:Organization
Organization Name:TESTATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SAALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-965-0770
Mailing Address - Street 1:212 DUNDEE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1627
Mailing Address - Country:US
Mailing Address - Phone:312-731-2434
Mailing Address - Fax:
Practice Address - Street 1:212 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1627
Practice Address - Country:US
Practice Address - Phone:312-731-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory