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NPI 1114791050

NPI 1114791050 : AME DIAGNOSTIC CENTER INC : CRETE, IL

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General NPI Number Information
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    NPI Number           |    1114791050
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    Entity Type          |    Organization 
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    Legal Business Name  |    AME DIAGNOSTIC CENTER INC 
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Dates
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    Enumeration Date     |    11/10/2023
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    Last Update Date     |    11/10/2025
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Provider Practice Location Address
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    Address Line         |    3670 AYR LN 
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    City                 |    CRETE
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    State                |    IL
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    Zip                  |    60417-1211
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    Country              |    US
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    Telephone            |    773-358-1393
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3670 AYR LN 
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    City                 |    CRETE
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    State                |    IL
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    Zip                  |    60417-1211
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    Country              |    US
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    Telephone            |    773-358-1393
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    Fax                  |    
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Authorized Official
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    Title or Position    |    PRESIDENT
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    Name                 |     CRYSTAL DAWN DUCHAJ 
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    Credential           |    
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    Telephone            |    773-358-1393
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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       |    
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    License Number State |    
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