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General NPI Number Information
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NPI Number | 1750362224
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Entity Type | Organization
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Legal Business Name | DOCTOR'S DATA, INC.
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 3755 ILLINOIS AVE
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City | ST CHARLES
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State | IL
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Zip | 60174-2420
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Country | US
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Telephone | 630-377-8139
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Fax | 630-587-7860
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Provider Business Mailing Address
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Address Line | 3755 ILLINOIS AVE
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City | ST CHARLES
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State | IL
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Zip | 60174-2420
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Country | US
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Telephone | 630-377-8139
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Fax | 630-587-7860
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DARRELL S HICKOK
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Credential |
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Telephone | 630-377-8139
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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 | 14D0646470
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License Number State | IL
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