Healthcare Provider Details

I. General information

NPI: 1326288853
Provider Name (Legal Business Name): ADVANCE DIAGNOSTICS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30500 NORTHWESTERN HWY STE 316C
FARMINGTON HILLS MI
48334-3178
US

IV. Provider business mailing address

30500 NORTHWESTERN HWY STE 316C
FARMINGTON HILLS MI
48334-3178
US

V. Phone/Fax

Practice location:
  • Phone: 248-539-8781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BORIS BERKOVICH
Title or Position: OPERATING MANAGER
Credential:
Phone: 248-935-6646