Provider Demographics
NPI:1831858612
Name:CITI DIAGNOSTICS INC
Entity type:Organization
Organization Name:CITI DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-997-4590
Mailing Address - Street 1:6201 N CALIFORNIA AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2627
Mailing Address - Country:US
Mailing Address - Phone:773-262-7600
Mailing Address - Fax:
Practice Address - Street 1:6201 N CALIFORNIA AVE STE 111
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2627
Practice Address - Country:US
Practice Address - Phone:773-262-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory