Provider Demographics
NPI:1326754268
Name:ACCORD MEDICAL LABS OF FL LLC
Entity Type:Organization
Organization Name:ACCORD MEDICAL LABS OF FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAJAHATUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-817-5928
Mailing Address - Street 1:343 N WOOD DALE RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1578
Mailing Address - Country:US
Mailing Address - Phone:773-817-5928
Mailing Address - Fax:
Practice Address - Street 1:6251 PARK BLVD N STE 1A
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3238
Practice Address - Country:US
Practice Address - Phone:773-817-5928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory