Healthcare Provider Details

I. General information

NPI: 1043166564
Provider Name (Legal Business Name): MAPLE DIAGNOSTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E RAND RD STE 107
MOUNT PROSPECT IL
60056-2184
US

IV. Provider business mailing address

259 E RAND RD STE 107
MOUNT PROSPECT IL
60056-2184
US

V. Phone/Fax

Practice location:
  • Phone: 224-615-5447
  • Fax:
Mailing address:
  • Phone: 224-615-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: HARSHITH VASIREDDY
Title or Position: PRESIDENT
Credential:
Phone: 224-615-5447