Diagnostic Medical Laboratory, Inc.

Primary specialty

Laboratory Management Specialist/TechnologistTaxonomy code 246QL0900X

Legal business name

DIAGNOSTIC MEDICAL LABORATORY, INC.

Practice address

4554 N. Broadway Street
Suite 317
Chicago, IL 60640-5642

Phone

(773) 255-4959

Fax

(773) 506-0269

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Joseph S Tengbeh Sr., MD.

Title

Laboratory Director and Owner

Phone

(773) 255-4959

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diagnostic Medical Laboratory, Inc. Doing business as

Locations

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1376685016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4554 N. BROADWAY STREET",
            "address_2": "SUITE 317",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405642",
            "telephone_number": "773-255-4959",
            "fax_number": "773-506-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4554 N. BROADWAY STREET",
            "address_2": "SUITE 317",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405642",
            "telephone_number": "773-255-4959",
            "fax_number": "773-506-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC MEDICAL LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "TENGBEH",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "LABORATORY DIRECTOR AND OWNER",
        "authorized_official_telephone_number": "773-255-4959",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "246QL0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Pathology, Laboratory Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20388576001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diagnostic Medical Laboratory, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Chicago, IL
• Laboratory Management Specialist/Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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.