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NPI Code Detail

MEDICARE: CANDU LAB SERVICES

MEDICARE: CANDU LAB SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical LaboratoryIN

General Provider Information

NPI Number : 1700064953
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANDU LAB SERVICES
Provider Business Mailing Address
First Line : 2118 INWOOD DR
Second Line : SUITE 121
City : FORT WAYNE
State : IN
Zip : 46815-7115
Country : US
Telephone Number : 260-804-6727
Fax Number : 260-918-0218
Provider Business Practice Location Address
First Line : 2118 INWOOD DR
Second Line : SUITE 121
City : FORT WAYNE
State : IN
Zip : 46815-7115
Country : US
Telephone Number : 260-804-6727
Fax Number : 260-918-0218
Authorized Official
Title or Position : PRESIDENT
Name : NICOLAE CANDU
Credential :
Telephone Number : 260-804-6727
Provider Enumeration Date : 02/08/2008
Last Update Date : 02/11/2008

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Directions to “CANDU LAB SERVICES ” Practice Location

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