MEDICARE: 7400 WESTERN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1033840707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	7400 WESTERN INC

Provider Business Mailing Address
First Line	:	7421 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1735
Country	:	US
Telephone Number	:	773-389-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	7421 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1735
Country	:	US
Telephone Number	:	773-389-7999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SYED HUSSAINI
Credential	:
Telephone Number	:	773-389-7999

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/22/2022

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