Provider Demographics
NPI:1609538313
Name:DELTA DIAGNOSTICS INC
Entity Type:Organization
Organization Name:DELTA DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAIK
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMATHULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-732-0517
Mailing Address - Street 1:111 DOLORES DR APT 10
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3439
Mailing Address - Country:US
Mailing Address - Phone:773-732-0517
Mailing Address - Fax:
Practice Address - Street 1:111 DOLORES DR APT 10
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3439
Practice Address - Country:US
Practice Address - Phone:773-732-0517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory