Organization
MEDICAL ASSAY LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTAPHER I CHALOKWU PH.D. (ADMINISTRATOR)
(630) 515-0418
Entity
Organization
Contact information
Practice address
6006 S CASS AVE STE A, WESTMONT, IL 60559-2780
(630) 515-0418
(630) 515-0417
Mailing address
6006 S CASS AVE STE A, WESTMONT, IL 60559-2780
(630) 515-0418
(630) 515-0417
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D1044662
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02232809
BLUE SHIELD PROVIDER NUMB
IL
05
—
200812370A
—
IN
Enumeration date
07/07/2006
Last updated
06/11/2010
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