Provider Demographics
NPI:1285758581
Name:DOCTORS CLINICAL LABORATORY INC
Entity type:Organization
Organization Name:DOCTORS CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUJAUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-448-8570
Mailing Address - Street 1:6177 N LINCOLN AVE # 348
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2313
Mailing Address - Country:US
Mailing Address - Phone:312-448-8570
Mailing Address - Fax:
Practice Address - Street 1:1685 WINNETKA CIR
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1372
Practice Address - Country:US
Practice Address - Phone:312-448-8570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1167724291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630245OtherBLUE CROSS BLUE SHIELDS
IL01630245OtherBLUE CROSS BLUE SHIELDS
IL76233Medicare ID - Type Unspecified