Provider Demographics
NPI:1639315724
Name:OAKRIDGE DIAGNOSTICS,INC
Entity Type:Organization
Organization Name:OAKRIDGE DIAGNOSTICS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KULAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-791-8778
Mailing Address - Street 1:1883 HICKS RD
Mailing Address - Street 2:C
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1254
Mailing Address - Country:US
Mailing Address - Phone:847-401-7475
Mailing Address - Fax:
Practice Address - Street 1:1883 HICKS RD
Practice Address - Street 2:C
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1254
Practice Address - Country:US
Practice Address - Phone:847-401-7475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty