Provider Demographics
NPI:1043962764
Name:NEXTGEN MEDICAL LABS LLC
Entity Type:Organization
Organization Name:NEXTGEN MEDICAL LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-245-4326
Mailing Address - Street 1:161 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1119
Mailing Address - Country:US
Mailing Address - Phone:224-460-5320
Mailing Address - Fax:
Practice Address - Street 1:161 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1119
Practice Address - Country:US
Practice Address - Phone:224-460-5320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory