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General NPI Number Information
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NPI Number | 1063924819
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC HEMATOLOGY, PC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 24725 W. TWELVE MILE ROAD SUITE 118
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 248-450-3179
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Fax | 248-327-6030
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Provider Business Mailing Address
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Address Line | 24725 W. TWELVE MILE ROAD
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 248-450-3179
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Fax | 248-327-6030
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Authorized Official
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Title or Position | ADMINSTRATION
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Name | MOE BADREDDINE
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Credential | ASCP
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Telephone | 248-450-3179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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