Provider Demographics
NPI:1811658024
Name:ILLINIOS TECH LAB INC
Entity type:Organization
Organization Name:ILLINIOS TECH LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAFEEQ UDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-952-3034
Mailing Address - Street 1:8244 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2909
Mailing Address - Country:US
Mailing Address - Phone:312-952-3034
Mailing Address - Fax:
Practice Address - Street 1:1818 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4106
Practice Address - Country:US
Practice Address - Phone:312-952-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory