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Individual

MITCHELL LAKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2250 W CAMPBELL PARK DR, CHICAGO, IL 60612-3502
(312) 243-0600
Mailing address
PO BOX 2240, BURLINGTON, NC 27216-2240

Taxonomy

Speciality
Code
Description
License number
State
246QL0901X
Diplomate Laboratory Management Specialist/Technologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14D0897314
CLIA
Enumeration date
07/09/2014
Last updated
07/09/2014
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