Provider Demographics
NPI:1083372973
Name:IL DIAGNOSTICS CORPORATION
Entity Type:Organization
Organization Name:IL DIAGNOSTICS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FEROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JALAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-999-3999
Mailing Address - Street 1:614 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5610
Mailing Address - Country:US
Mailing Address - Phone:773-999-3999
Mailing Address - Fax:
Practice Address - Street 1:614 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5610
Practice Address - Country:US
Practice Address - Phone:773-999-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory