Provider Demographics
NPI:1841961778
Name:INTEGRATIVE DIAGNOSTICS
Entity type:Organization
Organization Name:INTEGRATIVE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-325-4332
Mailing Address - Street 1:21237 S LA GRANGE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2047
Mailing Address - Country:US
Mailing Address - Phone:779-900-8389
Mailing Address - Fax:779-204-3903
Practice Address - Street 1:21237 S LA GRANGE RD STE 5
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2047
Practice Address - Country:US
Practice Address - Phone:779-900-8389
Practice Address - Fax:779-204-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory