Healthcare Provider Details

I. General information

NPI: 1730823147
Provider Name (Legal Business Name): ADNAN LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 W LAWRENCE AVE
CHICAGO IL
60630-1722
US

IV. Provider business mailing address

4719 W LAWRENCE AVE
CHICAGO IL
60630-1722
US

V. Phone/Fax

Practice location:
  • Phone: 773-853-2738
  • Fax:
Mailing address:
  • Phone: 773-853-2738
  • 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 Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED HAMED QURESHI
Title or Position: PRESIDENT
Credential:
Phone: 773-853-2738