Provider Demographics
NPI:1851019715
Name:PLATINUM LABORATORY INC
Entity type:Organization
Organization Name:PLATINUM LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:UNKNOWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED KALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-807-4508
Mailing Address - Street 1:4752 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5706
Mailing Address - Country:US
Mailing Address - Phone:773-807-4508
Mailing Address - Fax:
Practice Address - Street 1:4752 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5706
Practice Address - Country:US
Practice Address - Phone:773-807-4508
Practice Address - Fax:847-696-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory