Provider Demographics
NPI:1972625499
Name:AMERICAN SCIENTIFIC LABORATORY INC
Entity Type:Organization
Organization Name:AMERICAN SCIENTIFIC LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHFAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-262-3788
Mailing Address - Street 1:8744 N SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2143
Mailing Address - Country:US
Mailing Address - Phone:773-262-3788
Mailing Address - Fax:773-262-3655
Practice Address - Street 1:8744 N SHERMER RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2143
Practice Address - Country:US
Practice Address - Phone:773-262-3788
Practice Address - Fax:773-262-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D0919258291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL393580Medicare ID - Type Unspecified