Organization
DOCTOR'S DATA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL S HICKOK (CHIEF EXECUTIVE OFFICER)
(630) 377-8139
Entity
Organization
Contact information
Practice address
3755 ILLINOIS AVE, ST CHARLES, IL 60174-2420
(630) 377-8139
(630) 587-7860
Mailing address
3755 ILLINOIS AVE, ST CHARLES, IL 60174-2420
(630) 377-8139
(630) 587-7860
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D0646470
IL
Other
Enumeration date
11/10/2005
Last updated
03/30/2015
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