Provider Demographics
NPI:1871698282
Name:MEDWAY DIAGNOSTIC LABS INC
Entity type:Organization
Organization Name:MEDWAY DIAGNOSTIC LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BALBIR
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-762-4331
Mailing Address - Street 1:3138 WEST CERMAK ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3306
Mailing Address - Country:US
Mailing Address - Phone:773-762-4331
Mailing Address - Fax:773-762-4333
Practice Address - Street 1:3138 WEST CERMAK ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3306
Practice Address - Country:US
Practice Address - Phone:773-762-4331
Practice Address - Fax:773-762-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========01Medicaid
IL=========01Medicaid