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General NPI Number Information
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NPI Number | 1356001598
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Entity Type | Organization
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Legal Business Name | FORD PCR DRIVE THRU LLC
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 24517 FORD RD
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City | DEARBORN
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State | MI
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Zip | 48128-1131
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Country | US
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Telephone | 480-262-7993
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Fax |
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Provider Business Mailing Address
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Address Line | 24517 FORD RD
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City | DEARBORN
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State | MI
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Zip | 48128-1131
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Country | US
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Telephone | 480-262-7993
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. ALI HAZIMEH
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Credential | MD
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Telephone | 313-415-1515
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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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