Provider Demographics
NPI:1457244717
Name:TUSLA MEDICAL LAB
Entity type:Organization
Organization Name:TUSLA MEDICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-933-4859
Mailing Address - Street 1:332 S MICHIGAN AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4302
Mailing Address - Country:US
Mailing Address - Phone:888-473-3611
Mailing Address - Fax:
Practice Address - Street 1:4100 MADISON STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624
Practice Address - Country:US
Practice Address - Phone:888-473-3611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory