MEDICARE: A,GENERAL LAB CORP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689879249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A,GENERAL LAB CORP

Provider Business Mailing Address
First Line	:	1793 BLOOMINGDALE RD STE 1
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3800
Country	:	US
Telephone Number	:	630-933-9373
Fax Number	:	630-373-4545

Provider Business Practice Location Address
First Line	:	1793 BLOOMINGDALE RD STE 1
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3800
Country	:	US
Telephone Number	:	630-933-9373
Fax Number	:	630-373-4545

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SALMA MIRZA
Credential	:
Telephone Number	:	224-595-5100

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	06/16/2008

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Directions to “A,GENERAL LAB CORP ” Practice Location

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