Healthcare Provider Details

I. General information

NPI: 1497000509
Provider Name (Legal Business Name): AZRA LABS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 LEGACY PKWY SUITE 110
LANSING MI
48911-4265
US

IV. Provider business mailing address

2843 E GRAND RIVER AVE BOX 260
EAST LANSING MI
48823-6722
US

V. Phone/Fax

Practice location:
  • Phone: 517-206-1388
  • Fax:
Mailing address:
  • Phone: 517-206-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ASHER JAVAID BASHIR
Title or Position: PRESIDENT/CEO
Credential: J.D.
Phone: 517-206-1388