Organization
MEDSTAR LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJ N PATEL (VICE PRESIDENT)
(708) 488-1000
Entity
Organization
Contact information
Practice address
4531 HARRISON ST, HILLSIDE, IL 60162-1614
(708) 488-1000
(708) 488-1831
Mailing address
4531 HARRISON ST, HILLSIDE, IL 60162-1614
(708) 488-1000
(708) 488-1831
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D0945905
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144202003
NPI
—
01
—
506110
PTAN
—
Enumeration date
11/16/2005
Last updated
09/17/2015
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