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General NPI Number Information
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NPI Number | 1417316100
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Entity Type | Organization
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Legal Business Name | QUANTUM LABS
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 24555 SOUTHFIELD RD STE L-70
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2738
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Country | US
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Telephone | 248-262-7731
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Fax | 888-392-6043
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Provider Business Mailing Address
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Address Line | 1175 AMERICAN PACIFIC DR STE F
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City | HENDERSON
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State | NV
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Zip | 89074-8768
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Country | US
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Telephone | 702-637-0860
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Fax | 702-939-9064
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Authorized Official
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Title or Position | OWNER
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Name | OLUSEYI AYANGADE
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Credential |
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Telephone | 248-262-7731
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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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