Organization
ABC LABS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHIDA REHMAN (OWNER)
(708) 289-6328
Entity
Organization
Contact information
Practice address
6449 S PULASKI RD STE 108, CHICAGO, IL 60629-5148
(773) 306-1259
Mailing address
6449 S PULASKI RD STE 108, CHICAGO, IL 60629-5148
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D2118590
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D2118590
CLIA
IL
Enumeration date
05/27/2017
Last updated
05/27/2017
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