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General NPI Number Information
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NPI Number | 1023053691
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Entity Type | Organization
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Legal Business Name | O'HARE CLINICAL LAB SERVICES INC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 4909 W DIVISION ST STE 303
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City | CHICAGO
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State | IL
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Zip | 60651-3161
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Country | US
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Telephone | 800-839-2095
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Fax | 800-761-3075
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Provider Business Mailing Address
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Address Line | 1420 RENAISSANCE DR STE 206
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City | PARK RIDGE
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State | IL
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Zip | 60068-1342
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Country | US
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Telephone | 800-839-2095
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Fax | 800-761-3075
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MOHAMED SIRAJUDEEN
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Credential |
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Telephone | 773-552-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 14D1051792
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License Number State | IL
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