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General NPI Number Information
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NPI Number | 1649928607
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Entity Type | Organization
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Legal Business Name | MMM DIAGNOSTIC CENTER INC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 330 E ROOSEVELT RD STE 150
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City | LOMBARD
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State | IL
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Zip | 60148-4662
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Country | US
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Telephone | 630-216-9131
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Fax | 908-605-4974
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Provider Business Mailing Address
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Address Line | 330 E ROOSEVELT RD STE 150
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City | LOMBARD
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State | IL
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Zip | 60148-4662
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Country | US
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Telephone | 630-216-9131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AHMED GANATRA
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Credential |
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Telephone | 630-216-9131
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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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