Healthcare Provider Details

I. General information

NPI: 1487854352
Provider Name (Legal Business Name): BIOTECH CLINICAL LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD SUITE G04
LANSING MI
48912-3756
US

IV. Provider business mailing address

1540 LAKE LANSING RD SUITE G04
LANSING MI
48912-3756
US

V. Phone/Fax

Practice location:
  • Phone: 517-913-3990
  • Fax: 517-913-3994
Mailing address:
  • Phone: 517-913-3990
  • Fax: 517-913-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH KHALIFEH
Title or Position: PRESIDENT
Credential:
Phone: 248-426-0824