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General NPI Number Information
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NPI Number | 1275288862
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Entity Type | Organization
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Legal Business Name | NORTHWEST MEDICAL LAB INC
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 1315 BUTTERFIELD RD STE 201
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5602
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Country | US
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Telephone | 847-452-1011
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Fax | 847-876-8867
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Provider Business Mailing Address
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Address Line | 1315 BUTTERFIELD RD STE 201
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5602
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Country | US
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Telephone | 847-452-1011
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Fax | 847-876-8867
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARCELA CORRALES
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Credential |
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Telephone | 847-452-1011
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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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