MEDICARE: ACCULAB MEDICAL TESTING INC

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	097.000815	IL

General Provider Information

NPI Number	:	1699222000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCULAB MEDICAL TESTING INC

Provider Business Mailing Address
First Line	:	2600 S MICHIGAN AVE STE 212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2859
Country	:	US
Telephone Number	:	312-939-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S MICHIGAN AVE STE 212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2859
Country	:	US
Telephone Number	:	312-939-3535
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WARREN COOPER
Credential	:
Telephone Number	:	312-939-3535

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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