=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639821457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A TO Z LAB INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2022
-----------------------------------------------------
Last Update Date | 01/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 742 BARCLAY DR
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60440-6106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-696-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 742 BARCLAY DR
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60440-6106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-696-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | AYAAN KHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-696-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------