Provider Demographics
NPI:1932362720
Name:ANDROLOGY LABORATORY SERVICES INC
Entity Type:Organization
Organization Name:ANDROLOGY LABORATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAJASINGAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:JEYENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-335-0075
Mailing Address - Street 1:680 N LAKESHORE DR
Mailing Address - Street 2:SUITE 807 ANDROLOGY LABORATORY SERVICES INC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-335-0075
Mailing Address - Fax:312-335-0076
Practice Address - Street 1:680 N LAKESHORE DR
Practice Address - Street 2:SUITE 807 ANDROLOGY LABORATORY SERVICES INC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-335-0075
Practice Address - Fax:312-335-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1891855291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory