=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932069663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTPATH LAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2025
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14400 S ARCHER AVE UNIT 2
-----------------------------------------------------
City | LOCKPORT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60441-5806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-759-6500
-----------------------------------------------------
Fax | 305-509-5868
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14400 S ARCHER AVE UNIT 2
-----------------------------------------------------
City | LOCKPORT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60441-5806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-759-6500
-----------------------------------------------------
Fax | 305-509-5868
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AMMAD UL MULK
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 708-759-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------