Organization
IMPALA EXPRESS CLINICAL LABORATORY SERVICE INC
Active
Organization
IMPALA EXPRESS CLINICAL LABORATORY SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEMAYEHU M GEBRESELLASSIE (PRESIDENT)
(847) 951-5168
Entity
Organization
Contact information
Practice address
845 N MICHIGAN AVE STE 944E, 845 N. MICHIGAN AVE, SUITE # 944-E, CHICAGO, IL 60611-2213
(312) 202-0328
(312) 202-0320
Mailing address
845 N MICHIGAN AVE STE 944E, 845 N. MICHIGAN AVE, SUITE # 944-E, CHICAGO, IL 60611-2213
(312) 202-0328
(312) 202-0320
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D2018991
IL
Other
Enumeration date
04/12/2011
Last updated
06/12/2012
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