Provider Demographics
NPI:1043695786
Name:MOBILE DIAGNOSTIC SOLUTIONS, INC
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTIC SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-656-5392
Mailing Address - Street 1:350 S NORTHWEST HWY
Mailing Address - Street 2:STE 300
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4216
Mailing Address - Country:US
Mailing Address - Phone:847-656-5392
Mailing Address - Fax:847-656-5395
Practice Address - Street 1:350 S NORTHWEST HWY
Practice Address - Street 2:300
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4216
Practice Address - Country:US
Practice Address - Phone:847-656-5392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory