Provider Demographics
NPI:1275288862
Name:NORTHWEST MEDICAL LAB INC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL LAB INC
Other - Org Name:NORTHWEST MEDICAL LAB USA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-452-1011
Mailing Address - Street 1:1315 BUTTERFIELD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5602
Mailing Address - Country:US
Mailing Address - Phone:847-452-1011
Mailing Address - Fax:847-876-8867
Practice Address - Street 1:1315 BUTTERFIELD RD STE 201
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5602
Practice Address - Country:US
Practice Address - Phone:847-452-1011
Practice Address - Fax:847-876-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory