Provider Demographics
NPI:1518618925
Name:WAQAS TARIQ MEDICAL LLC
Entity Type:Organization
Organization Name:WAQAS TARIQ MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAQAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-666-0226
Mailing Address - Street 1:540 W ELLE ST
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5295
Mailing Address - Country:US
Mailing Address - Phone:815-666-0226
Mailing Address - Fax:
Practice Address - Street 1:540 W ELLE ST
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-5295
Practice Address - Country:US
Practice Address - Phone:815-666-0226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory