Healthcare Provider Details

I. General information

NPI: 1710656129
Provider Name (Legal Business Name): MSU HEALTH LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 HIGHLAND RD STE 210
WATERFORD MI
48327-1682
US

IV. Provider business mailing address

6620 HIGHLAND RD STE 210
WATERFORD MI
48327-1682
US

V. Phone/Fax

Practice location:
  • Phone: 888-275-5221
  • Fax: 888-275-5224
Mailing address:
  • Phone: 888-275-5221
  • Fax: 888-275-5224

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: ANDREA BRATTON
Title or Position: BILLING MANAGER
Credential:
Phone: 888-275-5221