=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083635163
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARDE MEDICAL LABORATORY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 W TEXTILE RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48108-9548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-214-0300
-----------------------------------------------------
Fax | 734-214-0399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 W TEXTILE RD
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48108-9548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-214-0300
-----------------------------------------------------
Fax | 734-214-0399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. KAJAL SITWALA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 734-214-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 23D0650611
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------