# DIAGNOSTIC MEDICAL LABORATORY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Diagnostic Medical Laboratory, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376685016
- **Authorized official:** DR. JOSEPH S TENGBEH SR. MD. (LABORATORY DIRECTOR AND OWNER)
- **Authorized official phone:** (773) 255-4959

## Contact information

- **Practice address:** 4554 N. BROADWAY STREET, SUITE 317, CHICAGO, IL 60640-5642
- **Practice address phone:** (773) 255-4959
- **Practice address fax:** (773) 506-0269
- **Mailing address:** 4554 N. BROADWAY STREET, SUITE 317, CHICAGO, IL 60640-5642
- **Mailing address phone:** (773) 255-4959
- **Mailing address fax:** (773) 506-0269

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246QL0900X | Laboratory Management Specialist/Technologist | — | NULL | Yes |
| 246QL0900X | Laboratory Management Specialist/Technologist | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 02/22/2012