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General NPI Number Information
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NPI Number | 1760414221
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSAY LABORATORY
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 6006 S CASS AVE STE A
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City | WESTMONT
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State | IL
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Zip | 60559-2780
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Country | US
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Telephone | 630-515-0418
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Fax | 630-515-0417
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Provider Business Mailing Address
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Address Line | 6006 S CASS AVE STE A
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City | WESTMONT
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State | IL
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Zip | 60559-2780
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Country | US
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Telephone | 630-515-0418
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Fax | 630-515-0417
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. CHRISTAPHER I CHALOKWU
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Credential | PH.D.
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Telephone | 630-515-0418
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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 | 14D1044662
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License Number State | IL
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