Organization
NORTHLAKE INTERNATIONAL MEDICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA DELLDEAN BROWN C.T. (IAC) (CEO)
(219) 985-1315
Entity
Organization
Contact information
Practice address
2200 GRANT ST, STE 201, GARY, IN 46404-3439
(219) 614-6833
Mailing address
234 W 46TH AVE, GARY, IN 46408-3908
(219) 985-1315
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05137901
IN
Other
Enumeration date
06/19/2005
Last updated
08/22/2020
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