Northlake International Medical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

05137901 Issued in IN

Legal business name

NORTHLAKE INTERNATIONAL MEDICAL LABORATORY

Practice address

2200 Grant St
Ste 201
Gary, IN 46404-3439

Phone

(219) 614-6833

NPI assigned

Jun 19, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Patricia Delldean Brown, C.T. (IAC)

Title

Ceo

Phone

(219) 985-1315

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1119139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265437818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 W 46TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464083908",
            "telephone_number": "219-985-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 GRANT ST",
            "address_2": "STE 201",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464043439",
            "telephone_number": "219-614-6833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE INTERNATIONAL MEDICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "DELLDEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-985-1315",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "C.T. (IAC)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IN",
            "license": "05137901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Gary, IN
• Providers in Gary, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.