Healthcare Provider Details

I. General information

NPI: 1548816135
Provider Name (Legal Business Name): VENOTECH PHLEBOTOMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23330 OAK GLEN DR
SOUTHFIELD MI
48033-3491
US

IV. Provider business mailing address

23330 OAK GLEN DR
SOUTHFIELD MI
48033-3491
US

V. Phone/Fax

Practice location:
  • Phone: 800-645-9829
  • Fax:
Mailing address:
  • Phone: 800-645-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: TANYA A STOVALL
Title or Position: MANAGER
Credential:
Phone: 800-645-9829