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General NPI Number Information
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NPI Number | 1952942039
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Entity Type | Organization
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Legal Business Name | ASE MEDICAL INSTITUTE
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 344 VICTORY DR
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City | PARK FOREST
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State | IL
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Zip | 60466-2003
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Country | US
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Telephone | 708-490-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 344 VICTORY DR
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City | PARK FOREST
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State | IL
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Zip | 60466-2003
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Country | US
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Telephone | 877-404-0704
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Fax | 877-505-2724
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Authorized Official
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Title or Position | OWNER / CEO
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Name | DR. M. MANDELA LEE
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Credential | MD, PHD(C), CLS(AAB)
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Telephone | 877-404-0704
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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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