=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477001527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENERAL LAB PROFESSIONALS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2016
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WESTBROOK CORPORATE CTR STE 300
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-709-1501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 WESTBROOK CORPORATE CTR STE 300
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-5709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-709-1501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MOHAMMED MOHSIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-709-1501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------