Organization Active NPI

Clinical Diagnostic Labs LTD

  • Clinical Medical Laboratory
  • Skokie, IL
National Provider Identifier
1154294502
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CLINICAL DIAGNOSTIC LABS LTD
Practice address
4652 Oakton St
Skokie, IL 60076-3145
Phone
(708) 529-5659
Fax
(708) 529-5885
NPI assigned
Sep 23, 2025
Last updated
Aug 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ansar A Mohammed
Title
Authorized Official
Phone
(773) 852-7866

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

4652 Oakton St
Skokie, IL 60076-3145

Mailing address

4652 Oakton St
Skokie, IL 60076-3145
Phone (708) 529-5659

Other identifiers 1

IdentifierTypeStateIssuer
14D2332681OtherILCLIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251119002469 IL Part B Supplier - Independent Clinical Laboratory 6800387671 Practice locations: Oakbrook Terrace, IL

National Provider Directory

National Provider Directory

Locations

1 Transam Plaza Dr
Ste 16B
Oakbrook Terrace, IL 60181
Phone (708) 529-5659

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786406400000",
    "number": "1154294502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4652 OAKTON ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763145",
            "telephone_number": "708-529-5659",
            "fax_number": "708-529-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4652 OAKTON ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763145",
            "telephone_number": "708-529-5659",
            "fax_number": "708-529-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL DIAGNOSTIC LABS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-23",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A",
        "authorized_official_last_name": "MOHAMMED",
        "authorized_official_first_name": "ANSAR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "773-852-7866"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D2332681",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.