Organization
SOUTHSHORE MEDI LAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ASHFAQ MUHAMMAD (PRESIDENT)
(773) 585-0480
Entity
Organization
Contact information
Practice address
4651 W 79TH ST STE 204, CHICAGO, IL 60652-1775
(773) 585-0480
(773) 585-0482
Mailing address
4651 W 79TH ST STE 204, CHICAGO, IL 60652-1775
(773) 585-0480
(773) 585-0482
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D2104608
IL
Other
Enumeration date
12/28/2015
Last updated
12/28/2015
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