Provider Demographics
NPI:1013687813
Name:AZMATH CORP
Entity Type:Organization
Organization Name:AZMATH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AZMATH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-507-7924
Mailing Address - Street 1:710 N MAVIS LN
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2574
Mailing Address - Country:US
Mailing Address - Phone:773-507-7924
Mailing Address - Fax:
Practice Address - Street 1:710 N MAVIS LN
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2574
Practice Address - Country:US
Practice Address - Phone:773-507-7924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory