Provider Demographics
NPI:1891459327
Name:MEDSTAR LAB INC
Entity Type:Organization
Organization Name:MEDSTAR LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-866-9712
Mailing Address - Street 1:7301 N LINCOLN AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1754
Mailing Address - Country:US
Mailing Address - Phone:312-866-9712
Mailing Address - Fax:
Practice Address - Street 1:7301 N LINCOLN AVE STE 109
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1754
Practice Address - Country:US
Practice Address - Phone:312-866-9712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-30
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251S00000XAgenciesCommunity/Behavioral Health