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General NPI Number Information
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NPI Number | 1598953390
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Entity Type | Organization
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Legal Business Name | US DIAGNOSTICS LAB INC
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Dates
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Enumeration Date | 10/06/2007
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Last Update Date | 10/06/2007
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Provider Practice Location Address
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Address Line | 7337 N WESTERN AVE STE 3
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City | CHICAGO
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State | IL
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Zip | 60645-1813
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Country | US
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Telephone | 773-465-1199
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Fax | 773-465-1188
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Provider Business Mailing Address
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Address Line | 7337 N WESTERN AVE STE 3
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City | CHICAGO
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State | IL
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Zip | 60645-1813
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Country | US
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Telephone | 773-465-1199
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Fax | 773-465-1188
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAKEEL AHMED
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Credential | B.S
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Telephone | 773-465-1199
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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 | 14D1068598
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License Number State | IL
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