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General NPI Number Information
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NPI Number | 1659203412
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Entity Type | Organization
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Legal Business Name | MIDWEST COMMUNITY LABORATORIES INC
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 9830 RIDGELAND AVE STE 115
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2667
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Country | US
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Telephone | 708-945-9375
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Fax |
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Provider Business Mailing Address
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Address Line | 9830 RIDGELAND AVE STE 115
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2667
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Country | US
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Telephone | 708-945-9375
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | THABET TALEB
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Credential |
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Telephone | 708-945-9375
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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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