Provider Demographics
NPI:1003606138
Name:MEDLAB PROFESSIONALS LLC
Entity type:Organization
Organization Name:MEDLAB PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELL
Authorized Official - Middle Name:FJ
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-310-0267
Mailing Address - Street 1:1096 VILLAGE CENTER PKWY UNIT 4
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6635
Mailing Address - Country:US
Mailing Address - Phone:630-310-0267
Mailing Address - Fax:
Practice Address - Street 1:1096 VILLAGE CENTER PKWY UNIT 4
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-6635
Practice Address - Country:US
Practice Address - Phone:630-310-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment