Provider Demographics
NPI:1720261746
Name:MEDLIFE HEALTHCARE INC.
Entity Type:Organization
Organization Name:MEDLIFE HEALTHCARE INC.
Other - Org Name:MEDLIFE DIAGNOSTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LATEEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-539-4100
Mailing Address - Street 1:6374 N LINCOLN AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1283
Mailing Address - Country:US
Mailing Address - Phone:773-539-4100
Mailing Address - Fax:773-539-9400
Practice Address - Street 1:6374 N LINCOLN AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1283
Practice Address - Country:US
Practice Address - Phone:773-539-4100
Practice Address - Fax:773-539-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1505Medicare PIN