Provider Demographics
NPI:1780824979
Name:AMERICAN CLINICAL LABS INC.
Entity Type:Organization
Organization Name:AMERICAN CLINICAL LABS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAZHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-620-9994
Mailing Address - Street 1:6422 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5422
Mailing Address - Country:US
Mailing Address - Phone:847-620-9994
Mailing Address - Fax:
Practice Address - Street 1:6422 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-5422
Practice Address - Country:US
Practice Address - Phone:847-620-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory