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General NPI Number Information
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NPI Number | 1093121188
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Entity Type | Individual
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Provider Name | MITCHELL LAKS
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Gender | Male
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 2250 W CAMPBELL PARK DR
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City | CHICAGO
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State | IL
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Zip | 60612-3502
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Country | US
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Telephone | 312-243-0600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2240
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City | BURLINGTON
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State | NC
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Zip | 27216-2240
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QL0901X
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Taxonomy Name | Diplomate Laboratory Management Specialist/Technologist
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License Number |
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License Number State |
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