Provider Demographics
NPI:1295407468
Name:UNITED EG LLC
Entity type:Organization
Organization Name:UNITED EG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL ANSAR AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-445-1109
Mailing Address - Street 1:616 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4741
Mailing Address - Country:US
Mailing Address - Phone:630-445-1109
Mailing Address - Fax:
Practice Address - Street 1:616 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4741
Practice Address - Country:US
Practice Address - Phone:630-445-1109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED EG LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-05
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory