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General NPI Number Information
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NPI Number | 1851392617
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Entity Type | Organization
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Legal Business Name | DOCTORS GENERAL LABORATORY CORP
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 59 OGDEN AVE
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-1026
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Country | US
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Telephone | 708-599-5666
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Fax | 708-599-8737
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Provider Business Mailing Address
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Address Line | 9243 S ROBERTS RD
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City | HICKORY HILLS
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State | IL
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Zip | 60457-2079
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MAHENDRA H PATEL
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Credential |
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Telephone | 708-599-5666
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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 | 001
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 14D0419924
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License Number State | IL
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