Provider Demographics
NPI:1922565506
Name:LIFESCAN LABS OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:LIFESCAN LABS OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIYAHU
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-663-8300
Mailing Address - Street 1:9855 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1127
Mailing Address - Country:US
Mailing Address - Phone:847-663-8300
Mailing Address - Fax:
Practice Address - Street 1:5255 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1106
Practice Address - Country:US
Practice Address - Phone:847-663-8300
Practice Address - Fax:847-663-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory