MEDICARE: ADNAN LAB 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	310500000X	Mental Illness Intermediate Care Facility
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1730823147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADNAN LAB INC

Provider Business Mailing Address
First Line	:	4719 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1722
Country	:	US
Telephone Number	:	773-853-2738
Fax Number	:

Provider Business Practice Location Address
First Line	:	4719 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1722
Country	:	US
Telephone Number	:	773-853-2738
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMED HAMED QURESHI
Credential	:
Telephone Number	:	773-853-2738

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2022

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