Illinios Tech Lab Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ILLINIOS TECH LAB INC

Practice address

1818 Skokie Blvd
Northbrook, IL 60062-4106

Phone

(312) 952-3034

NPI assigned

Jan 10, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shafeeq Uddin Khaja

Title

President

Phone

(312) 952-3034

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1811658024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8244 CENTRAL PARK AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762909",
            "telephone_number": "312-952-3034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 SKOKIE BLVD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600624106",
            "telephone_number": "312-952-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINIOS TECH LAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "KHAJA",
        "authorized_official_first_name": "SHAFEEQ UDDIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-952-3034"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chimaobi Ibeabuchi
• Emily E Iglar, LCSW
• Ogoamaka C Igwe
• Maureen Ikpeama, MD
• Alyssa Illian
• Illinois Professionals Health Program, LLC
• Img Capital LLC
• Img Sound LLC
• In Home Health LLC
• In Home Health LLC

• Clinical Medical Laboratory in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.