Provider Demographics
NPI:1215502349
Name:SOUTH CHICAGO LAB LIMITED
Entity type:Organization
Organization Name:SOUTH CHICAGO LAB LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU-SHAQRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:815-440-9285
Mailing Address - Street 1:10215 S 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1302
Mailing Address - Country:US
Mailing Address - Phone:815-440-9285
Mailing Address - Fax:
Practice Address - Street 1:8058 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5936
Practice Address - Country:US
Practice Address - Phone:815-440-9285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty