DIAGNOSTIC MEDICAL LABORATORY, INC. (NPI# 1376685016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376685016 |
| Entity Type | Organization |
| Organization Name | DIAGNOSTIC MEDICAL LABORATORY, INC. |
| Other Organization Name | DIAGNOSTIC MEDICAL LABORATORY, INC. |
| Practice Address |
4554 N. Broadway Street Suite 317 Chicago IL 60640-5642 |
| Practice Telephone | 7732554959 |
| Practice Fax Number | 7735060269 |
| Mailing Telephone | 7732554959 |
| Mailing Fax Number | 7735060269 |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2012-02-22 |
| Authorized Official Name | DR. JOSEPH S TENGBEH SR. (LABORATORY DIRECTOR AND OWNER) |
| Authorized Official Telephone | 7732554959 |
| Authorized Official Credential | MD. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246QL0900X |
Spec/Tech, Pathology Specialization: Laboratory Management |
Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 20388576001 | 05 |
| Other Name | Type Code |
|---|---|
| Diagnostic Medical Laboratory, Inc. | Doing Business As Name - Organization |
| Street Address |
4554 N. BROADWAY STREET SUITE 317 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60640-5642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306371406 | Illinois Homecare and Training, Inc. | Home Health | 4554 N. Broadway Street, Suite 316, Chicago, IL 60640 | 2017-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754233 | Rci (wrs), LLC. | Clinic/Center | 5221-23 North Broadway, Chicago, IL 60640 | 2020-09-09 |
| 1548871916 | Borici Counseling LLC | Counselor | 4731 N Paulina St, Chicago, IL 60640 | 2020-08-11 |
| 1306319173 | Gerardo Garcia | Physician Assistant | Medical Staff Office, Weiss Memorial Hospital, 4646 N Marine Drive, Chicago, IL 60640 | 2019-01-04 |
| 1386121283 | Aea Optical Ventures, LLC | Clinic/Center | 4814 N Clark St, Chicago, IL 60640 | 2018-07-24 |
| 1023503885 | Lauren Vassiliades | Internal Medicine | Weiss Memorial Hospital, Medical Education Dpt., 4646 N. Marine Drive, C Elevators, 7th Flr. # 7100, Chicago, IL 60640 | 2018-06-25 |
| 1477061620 | Yesenia Vargas | Nurse Practitioner | 1025 W Sunnyside, Chicago, IL 60640 | 2018-01-22 |
| 1932622206 | Jasleen Kaur Brar | Internal Medicine | 4646 N. Marine Dr., Chicago, IL 60640 | 2017-07-19 |
| 1750802849 | Umer Mukhtar | Internal Medicine | 4646 N. Marine Dr. Med Ed Dept. C Elevators., Weiss Memorial Hospital. 7 Floor. #7100, Chicago, IL 60640 | 2017-06-29 |
| 1184144081 | Ellie Navidson | Registered Nurse | 1015 W Lawrence, 2nd Floor, Chicago, IL 60640 | 2017-06-21 |
| 1962932558 | Jennifer Stridh | Marriage & Family Therapist | 5125 N. Winthrop Ave, 1f, Chicago, IL 60640 | 2017-06-15 |
| Find all providers in zip 60640 | ||||
| Taxonomy Code | 246QL0900X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Spec/Tech, Pathology |
| Specialization | Laboratory Management |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811595150 | Lisa Porter | Spec/Tech, Pathology | 2125 S 22nd Ave, Broadview, IL 60155-2807 | 2020-10-09 |
| 1942798996 | Nicole Andreoli | Spec/Tech, Pathology | 310 W Losey St, Scott Afb, IL 62225-5250 | 2018-04-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.