Provider Demographics
NPI:1952942039
Name:ASE MEDICAL INSTITUTE
Entity Type:Organization
Organization Name:ASE MEDICAL INSTITUTE
Other - Org Name:ASE CLINICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:MANDELA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD, CLS(AAB)
Authorized Official - Phone:708-490-3340
Mailing Address - Street 1:344 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2003
Mailing Address - Country:US
Mailing Address - Phone:708-490-3340
Mailing Address - Fax:
Practice Address - Street 1:344 VICTORY DR
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2003
Practice Address - Country:US
Practice Address - Phone:708-490-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty