Healthcare Provider Details

I. General information

NPI: 1740109123
Provider Name (Legal Business Name): SOUTHWEST DIRECT DIAGNOSTIC LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W ROOSEVELT RD STE 31
WEST CHICAGO IL
60185-4806
US

IV. Provider business mailing address

245 W ROOSEVELT RD STE 31
WEST CHICAGO IL
60185-4806
US

V. Phone/Fax

Practice location:
  • Phone: 346-771-1189
  • Fax: 346-771-1189
Mailing address:
  • Phone: 346-771-1189
  • Fax: 346-771-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROMAAN ALI BAIG MIRZA
Title or Position: DME
Credential:
Phone: 346-771-1189