Provider Demographics
NPI:1902552169
Name:SENTINEL MEDICAL LABORATORIES
Entity Type:Organization
Organization Name:SENTINEL MEDICAL LABORATORIES
Other - Org Name:SEASONS LABCORP LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-678-8999
Mailing Address - Street 1:3500 W DEVON AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1300
Mailing Address - Country:US
Mailing Address - Phone:847-410-7561
Mailing Address - Fax:847-410-7562
Practice Address - Street 1:3500 W DEVON AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1300
Practice Address - Country:US
Practice Address - Phone:847-410-7561
Practice Address - Fax:847-410-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory