=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124740758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMZ MEDICAL AND DIAGNOSTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2022
-----------------------------------------------------
Last Update Date | 09/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 653 METROPOLITAN WAY
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-678-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1228 S LEO CT
-----------------------------------------------------
City | PALATINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60067-2388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-678-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MUHAMMAD KHAWARI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-678-9009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------