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General NPI Number Information
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NPI Number | 1386305514
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL GROUP LTD
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 148 S BOLINGBROOK DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2852
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Country | US
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Telephone | 630-914-5373
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Fax |
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Provider Business Mailing Address
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Address Line | 148 S BOLINGBROOK DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2852
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Country | US
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Telephone | 630-914-5373
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | YASER DAKHLALLAH
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Credential |
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Telephone | 630-229-1280
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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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