Provider Demographics
NPI:1457078784
Name:IL DIAGNOSTICS CORP
Entity type:Organization
Organization Name:IL DIAGNOSTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHALIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-417-0903
Mailing Address - Street 1:1580 N NORTHWEST HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1464
Mailing Address - Country:US
Mailing Address - Phone:844-417-0903
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY STE 6
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1464
Practice Address - Country:US
Practice Address - Phone:872-946-7074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory