Provider Demographics
NPI:1811658644
Name:NISA ESTATES LLC
Entity type:Organization
Organization Name:NISA ESTATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHOUDHRY
Authorized Official - Middle Name:I
Authorized Official - Last Name:TARAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-817-7965
Mailing Address - Street 1:5757 N LINCOLN AVE STE 19
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4729
Mailing Address - Country:US
Mailing Address - Phone:773-817-7965
Mailing Address - Fax:
Practice Address - Street 1:5757 N LINCOLN AVE STE 19
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4729
Practice Address - Country:US
Practice Address - Phone:773-817-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory