Healthcare Provider Details

I. General information

NPI: 1518890896
Provider Name (Legal Business Name): PRIME CORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 BEECH DALY ROAD 202A
DEARBORN HEIGHTS MI
48125
US

IV. Provider business mailing address

4245 BEECH DALY ROAD 202A
DEARBORN HEIGHTS MI
48125-1576
US

V. Phone/Fax

Practice location:
  • Phone: 586-210-0861
  • Fax:
Mailing address:
  • Phone: 586-210-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SUMITHRA CHUNDRU
Title or Position: OWNER
Credential:
Phone: 586-210-0861