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General NPI Number Information
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NPI Number | 1932362720
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Entity Type | Organization
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Legal Business Name | ANDROLOGY LABORATORY SERVICES INC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 680 N LAKESHORE DR SUITE 807 ANDROLOGY LABORATORY SERVICES INC
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-335-0075
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Fax | 312-335-0076
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Provider Business Mailing Address
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Address Line | 680 N LAKESHORE DR SUITE 807 ANDROLOGY LABORATORY SERVICES INC
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 312-335-0075
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Fax | 312-335-0076
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Authorized Official
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Title or Position | LABORATORY MANAGER
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Name | RAJASINGAM S JEYENDRAN
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Credential | PHD
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Telephone | 312-335-0075
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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 | 1891855
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License Number State | IL
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