Provider Demographics
NPI:1790437366
Name:ELGIN LAB DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:ELGIN LAB DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:708-581-8304
Mailing Address - Street 1:1339 N ARTESIAN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6962
Mailing Address - Country:US
Mailing Address - Phone:206-234-7715
Mailing Address - Fax:
Practice Address - Street 1:229 W GRAND AVE STE R
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3365
Practice Address - Country:US
Practice Address - Phone:708-581-8304
Practice Address - Fax:877-389-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No347C00000XTransportation ServicesPrivate Vehicle