Provider Demographics
NPI:1386395259
Name:DISCOVER LAB SERVICES LLC
Entity type:Organization
Organization Name:DISCOVER LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHABAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHAROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-865-9587
Mailing Address - Street 1:3209 W BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:224-333-1892
Mailing Address - Fax:
Practice Address - Street 1:3209 W BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659
Practice Address - Country:US
Practice Address - Phone:773-865-9587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory