Healthcare Provider Details

I. General information

NPI: 1912669755
Provider Name (Legal Business Name): HUSSEIN DIAB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 2ND AVE STE 4103
DETROIT MI
48201-2658
US

IV. Provider business mailing address

PO BOX 219
DEARBORN HEIGHTS MI
48127-0219
US

V. Phone/Fax

Practice location:
  • Phone: 313-437-3422
  • Fax:
Mailing address:
  • Phone: 313-437-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: