Provider Demographics
NPI:1790429215
Name:IYFMOA LABS INC
Entity Type:Organization
Organization Name:IYFMOA LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ILIYAZ
Authorized Official - Middle Name:H
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-786-8336
Mailing Address - Street 1:6204 N FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4747 W PETERSON AVE # SUT-402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5712
Practice Address - Country:US
Practice Address - Phone:847-786-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
384848747OtherOTHER