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General NPI Number Information
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NPI Number | 1508187147
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Entity Type | Organization
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Legal Business Name | AFFORDABLE LAB LLC
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 2530 CROOKS RD STE 2
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City | ROYAL OAK
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State | MI
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Zip | 48073-3300
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Country | US
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Telephone | 248-435-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 2530 CROOKS RD STE 2
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City | ROYAL OAK
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State | MI
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Zip | 48073-3300
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Country | US
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Telephone | 248-435-8050
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. RHONDA SHEPPEARD
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Credential |
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Telephone | 248-435-8050
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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 | 23D2007223
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License Number State | MI
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