Healthcare Provider Details

I. General information

NPI: 1073985727
Provider Name (Legal Business Name): TOXUSA LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W EDISON RD SUITE 5
MISHAWAKA IN
46545-3184
US

IV. Provider business mailing address

236 W EDISON RD SUITE 5
MISHAWAKA IN
46545-3184
US

V. Phone/Fax

Practice location:
  • Phone: 574-703-2272
  • Fax: 574-343-1505
Mailing address:
  • Phone: 574-703-2272
  • Fax: 574-343-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number15D2102246
License Number StateIN

VIII. Authorized Official

Name: EYAD KHADR
Title or Position: OWNER
Credential:
Phone: 574-703-2272