Provider Demographics
NPI:1124753249
Name:SH DIAGNOSTICS INC
Entity type:Organization
Organization Name:SH DIAGNOSTICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAFIUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-722-6925
Mailing Address - Street 1:3525 W PETERSON AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3313
Mailing Address - Country:US
Mailing Address - Phone:312-722-6925
Mailing Address - Fax:
Practice Address - Street 1:3525 W PETERSON AVE STE 117
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3313
Practice Address - Country:US
Practice Address - Phone:312-722-6925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D2263216OtherCLIA