Healthcare Provider Details

I. General information

NPI: 1235527516
Provider Name (Legal Business Name): MAPLEVIEW LABORATORY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35200 DEQUINDRE RD SUITE 100
STERLING HEIGHTS MI
48310-4837
US

IV. Provider business mailing address

35200 DEQUINDRE RD SUITE 100
STERLING HEIGHTS MI
48310-4837
US

V. Phone/Fax

Practice location:
  • Phone: 586-826-8600
  • Fax: 248-545-4737
Mailing address:
  • Phone: 586-826-8600
  • Fax: 248-545-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number23D1020287
License Number StateMI

VIII. Authorized Official

Name: JAMES LITTLE
Title or Position: OWNER/DOCTOR
Credential: MD
Phone: 586-826-8600