Healthcare Provider Details

I. General information

NPI: 1316271919
Provider Name (Legal Business Name): ADVANCE DIAGNOSTICS LABORATORIES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 CENTERPOINT PKWY SUITE 100
PONTIAC MI
48341
US

IV. Provider business mailing address

387 SHUMAN BLVD STE 210E
NAPERVILLE IL
60563-8146
US

V. Phone/Fax

Practice location:
  • Phone: 248-690-6360
  • Fax: 844-437-6590
Mailing address:
  • Phone: 248-690-6360
  • Fax: 844-437-6590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED ISRAR
Title or Position: CHAIRMAN
Credential:
Phone: 408-202-7950