Healthcare Provider Details

I. General information

NPI: 1255086419
Provider Name (Legal Business Name): MS INJECTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6338 W GUNNISON ST
CHICAGO IL
60630-2954
US

IV. Provider business mailing address

6338 W GUNNISON ST
CHICAGO IL
60630-2954
US

V. Phone/Fax

Practice location:
  • Phone: 773-553-9648
  • Fax:
Mailing address:
  • Phone: 773-553-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE MCCULLOUGH
Title or Position: LAB DIRECTOR
Credential:
Phone: 773-553-9648