Healthcare Provider Details

I. General information

NPI: 1467612895
Provider Name (Legal Business Name): MEQUON LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 N PORT WASHINGTON RD
MEQUON WI
53092-5585
US

IV. Provider business mailing address

10500 N PORT WASHINGTON ROAD
MEQUON WI
53092
US

V. Phone/Fax

Practice location:
  • Phone: 262-240-0427
  • Fax: 262-240-0429
Mailing address:
  • Phone: 262-240-0427
  • Fax: 262-240-0429

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: LAWRENCE A KANE III
Title or Position: OWNER
Credential: LCSW
Phone: 262-240-0427