Healthcare Provider Details

I. General information

NPI: 1104044957
Provider Name (Legal Business Name): DETROIT BIO MEDICAL LABORATORIES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

23955 FREEWAY PARK DR
FARMINGTON HILLS MI
48335-2817
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-1652
  • Fax: 248-471-2340
Mailing address:
  • Phone: 248-471-4111
  • Fax: 248-471-2340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number002174
License Number StateMI

VIII. Authorized Official

Name: RAYMOND P ZAKARIA
Title or Position: MANAGER
Credential: MS
Phone: 248-471-4111