=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972625499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN SCIENTIFIC LABORATORY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 06/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8744 N SHERMER RD
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60714-2143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-262-3788
-----------------------------------------------------
Fax | 773-262-3655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8744 N SHERMER RD
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60714-2143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-262-3788
-----------------------------------------------------
Fax | 773-262-3655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MUHAMMAD ASHFAQ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-262-3788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 14D0919258
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------