Organization
MEDVISTA LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MWESIGWA NURSE (PRESIDENT)
(773) 218-1004
Entity
Organization
Contact information
Practice address
3138 W CERMAK RD, SUITE 103, CHICAGO, IL 60623-3306
(773) 762-4331
(773) 762-4333
Mailing address
3029 E 92ND ST, SUITE 1, CHICAGO, IL 60617-4500
(773) 218-1004
(773) 762-4333
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D2011212
IL
Other
Enumeration date
09/22/2010
Last updated
09/22/2010
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