Provider Demographics
NPI:1215254891
Name:MEDLIFE DIAGNOSTIC SERVICES, INC
Entity type:Organization
Organization Name:MEDLIFE DIAGNOSTIC SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:773-396-9655
Mailing Address - Fax:773-539-9400
Practice Address - Street 1:8892 LOUISIANA ST STE B
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7153
Practice Address - Country:US
Practice Address - Phone:219-769-1900
Practice Address - Fax:219-769-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier