Provider Demographics
NPI:1366184004
Name:CHILABORATORYLLC
Entity type:Organization
Organization Name:CHILABORATORYLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FNU
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED FAROOQ ADIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-344-5018
Mailing Address - Street 1:9648 KEDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1120
Mailing Address - Country:US
Mailing Address - Phone:773-344-5018
Mailing Address - Fax:
Practice Address - Street 1:817 W LINCOLN HWY STE A
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3002
Practice Address - Country:US
Practice Address - Phone:773-344-5018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory