MEDICARE: ADVANCE MEDICAL LAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		IL

General Provider Information

NPI Number	:	1083710024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE MEDICAL LAB

Provider Business Mailing Address
First Line	:	1793 BLOOMINGDALE RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3800
Country	:	US
Telephone Number	:	630-373-4545
Fax Number	:	630-933-9371

Provider Business Practice Location Address
First Line	:	1793 BLOOMINGDALE RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3800
Country	:	US
Telephone Number	:	630-373-4545
Fax Number	:	630-933-9371

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MOHAMMED M AHMED
Credential	:
Telephone Number	:	630-373-4545

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	08/22/2020

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Directions to “ADVANCE MEDICAL LAB ” Practice Location

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