Healthcare Provider Details

I. General information

NPI: 1730098674
Provider Name (Legal Business Name): SOUTHEAST HARBOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 5TH ST STE 206A
MONROE MI
48161-1474
US

IV. Provider business mailing address

20 W 5TH ST STE 206A
MONROE MI
48161-1474
US

V. Phone/Fax

Practice location:
  • Phone: 985-999-6575
  • Fax:
Mailing address:
  • Phone:
  • 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: MARC SINCLAIR
Title or Position: BILLING
Credential:
Phone: 985-999-6575