Healthcare Provider Details

I. General information

NPI: 1548926512
Provider Name (Legal Business Name): MAK LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 N LINCOLN AVE STE 223
CHICAGO IL
60659-4668
US

IV. Provider business mailing address

5875 N LINCOLN AVE STE 223
CHICAGO IL
60659-4668
US

V. Phone/Fax

Practice location:
  • Phone: 773-828-2945
  • Fax:
Mailing address:
  • Phone: 312-696-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SYED ANWAR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 312-696-9836