Provider Demographics
NPI:1316240880
Name:AMERICAN DIAGNOSTIC LABORATORY INC
Entity type:Organization
Organization Name:AMERICAN DIAGNOSTIC LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-674-8600
Mailing Address - Street 1:7841 GROSS POINT RD UNIT A-1
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2617
Mailing Address - Country:US
Mailing Address - Phone:847-674-8600
Mailing Address - Fax:847-674-8603
Practice Address - Street 1:7841 GROSS POINT RD UNIT A-1
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2617
Practice Address - Country:US
Practice Address - Phone:847-674-8600
Practice Address - Fax:847-674-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D2015532291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory