Provider Demographics
NPI:1013154475
Name:CYTOGENETICS CONSULTANTS, INC
Entity Type:Organization
Organization Name:CYTOGENETICS CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-735-0976
Mailing Address - Street 1:2825 N HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5105
Mailing Address - Country:US
Mailing Address - Phone:773-472-4949
Mailing Address - Fax:773-871-5221
Practice Address - Street 1:2825 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5105
Practice Address - Country:US
Practice Address - Phone:773-472-4949
Practice Address - Fax:773-871-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D0950847291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0950847OtherCLIA