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General NPI Number Information
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NPI Number | 1841961778
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE DIAGNOSTICS
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 21237 S LA GRANGE RD STE 5
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City | FRANKFORT
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State | IL
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Zip | 60423-2047
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Country | US
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Telephone | 779-900-8389
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Fax | 779-204-3903
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Provider Business Mailing Address
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Address Line | 21237 S LA GRANGE RD STE 5
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City | FRANKFORT
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State | IL
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Zip | 60423-2047
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Country | US
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Telephone | 779-900-8389
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Fax | 779-204-3903
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. REHAN M MOHAMMED
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Credential |
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Telephone | 872-325-4332
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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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