Il Diagnostics Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

IL DIAGNOSTICS CORP

Practice address

1580 N Northwest Hwy Ste 6
Park Ridge, IL 60068-1464

Phone

(872) 946-7074

NPI assigned

Oct 26, 2022

Organization subpart

No

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

Authorized official

Name

Mohammed A Khalidi

Title

Owner

Phone

(844) 417-0903

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

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

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741910400000",
    "number": "1457078784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 N NORTHWEST HWY STE 6",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681464",
            "telephone_number": "844-417-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 N NORTHWEST HWY STE 6",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681464",
            "telephone_number": "872-946-7074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IL DIAGNOSTICS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-26",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A",
        "authorized_official_last_name": "KHALIDI",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "844-417-0903"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jae Hyun, MD
• Thomas A. Iannucci, M.D.
• Rafaello Vincens Uy Ibrado
• Nino Idoidze, MD
• Mohammad Ikramuddin, M.D.
• Illinois Bone and Joint Institute LLC
• Illinois Bone and Joint Institute LLC
• Illinois Bone and Joint Institute LLC
• Illinois Bone and Joint Institute LLC
• Illinois Dermatology Institute, LLC

• Clinical Medical Laboratory in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; 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.