Individual provider Active NPI

Ninef John Ishoo

  • Medical Laboratory Technician
  • Park Ridge, IL
National Provider Identifier
1902798861
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Laboratory TechnicianTaxonomy code 246RM2200X
License
14D2320480 Issued in IL
Practice address
2644 Dempster St Ste 202
Park Ridge, IL 60068-8431
Phone
(312) 804-3794
NPI assigned
Jul 16, 2025
Last updated
Jul 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Laboratory Technician 246RM2200X 14D2320480 IL Primary

Addresses

Primary practice location

2644 Dempster St Ste 202
Park Ridge, IL 60068-8431

Mailing address

2644 Dempster St Ste 202
Park Ridge, IL 60068-8431
Phone (224) 361-3054

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
14D2320480ILMDMedical Laboratory Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Health Labs LLC Current Accepting new patients

Locations

2644 Dempster St
Ste 202
Park Ridge, IL 60068
Phone (224) 361-3054

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1902798861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2644 DEMPSTER ST STE 202",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600688431",
            "telephone_number": "224-361-3054",
            "fax_number": "224-875-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2644 DEMPSTER ST STE 202",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600688431",
            "telephone_number": "312-804-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHOO",
        "first_name": "NINEF",
        "middle_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RM2200X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": "IL",
            "license": "14D2320480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.