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General NPI Number Information
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NPI Number | 1912472358
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Entity Type | Organization
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Legal Business Name | GRACE LAB SERVICES INC
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 6191 N CANFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3845
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Country | US
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Telephone | 773-763-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 6191 N CANFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3845
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Country | US
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Telephone | 773-763-7606
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYED ASIF KHUNDMIR
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Credential |
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Telephone | 773-763-7606
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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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