MEDICARE: ADVANCE DIAGNOSTICS LABORATORIES CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
3	2085U0001X	Diagnostic Ultrasound Physician
4	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1316271919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE DIAGNOSTICS LABORATORIES CORPORATION

Provider Business Mailing Address
First Line	:	387 SHUMAN BLVD STE 210E
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8146
Country	:	US
Telephone Number	:	248-690-6360
Fax Number	:	844-437-6590

Provider Business Practice Location Address
First Line	:	3959 CENTERPOINT PKWY
Second Line	:	SUITE 100
City	:	PONTIAC
State	:	MI
Zip	:	48341
Country	:	US
Telephone Number	:	248-690-6360
Fax Number	:	844-437-6590

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	MOHAMMED ISRAR
Credential	:
Telephone Number	:	408-202-7950

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	02/02/2026

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