Individual
UNKNOWN IMTIYAZ PASHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4539 N SHERIDAN RD, CHICAGO, IL 60640-5618
(773) 432-7187
Mailing address
6759 N CLARK ST, CHICAGO, IL 60626-3220
(773) 432-7187
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D2557061
LICENSE
IL
Enumeration date
05/31/2022
Last updated
08/26/2022
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