Provider Demographics
NPI:1598953390
Name:US DIAGNOSTICS LAB INC
Entity Type:Organization
Organization Name:US DIAGNOSTICS LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:773-465-1199
Mailing Address - Street 1:7337 N WESTERN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1813
Mailing Address - Country:US
Mailing Address - Phone:773-465-1199
Mailing Address - Fax:773-465-1188
Practice Address - Street 1:7337 N WESTERN AVE STE 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1813
Practice Address - Country:US
Practice Address - Phone:773-465-1199
Practice Address - Fax:773-465-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-06
Last Update Date:2007-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D1068598291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory