Provider Demographics
NPI:1710516455
Name:CHICAGO LABORATORY CONSULTANT LLC
Entity Type:Organization
Organization Name:CHICAGO LABORATORY CONSULTANT LLC
Other - Org Name:ALC DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & SCIENTIFIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:872-201-8236
Mailing Address - Street 1:2434 E DEMPSTER ST STE 109
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5339
Mailing Address - Country:US
Mailing Address - Phone:872-201-8236
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE STE 1605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3055
Practice Address - Country:US
Practice Address - Phone:872-201-8236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-05
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty