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General NPI Number Information
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NPI Number | 1316271919
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Entity Type | Organization
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Legal Business Name | ADVANCE DIAGNOSTICS LABORATORIES CORPORATION
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 3959 CENTERPOINT PKWY SUITE 100
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City | PONTIAC
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State | MI
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Zip | 48341
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Country | US
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Telephone | 248-690-6360
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Fax | 844-437-6590
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Provider Business Mailing Address
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Address Line | 387 SHUMAN BLVD STE 210E
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City | NAPERVILLE
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State | IL
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Zip | 60563-8146
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Country | US
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Telephone | 248-690-6360
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Fax | 844-437-6590
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MOHAMMED ISRAR
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Credential |
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Telephone | 408-202-7950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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