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General NPI Number Information
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NPI Number | 1548682917
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Entity Type | Organization
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Legal Business Name | MICHIGAN MEDICAL LABORATORY LLC
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5732 ALEXIS ROAD
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City | SYLVANIA
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State | OH
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Zip | 43560
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Country | US
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Telephone | 248-254-3950
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Fax | 248-254-3951
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Provider Business Mailing Address
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Address Line | 5732 ALEXIS ROAD
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City | SYLVANIA
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State | OH
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Zip | 43560
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Country | US
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Telephone | 248-254-3950
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Fax | 248-254-3951
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ELIZABETH MARY KNISLEY
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Credential | CEO
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Telephone | 734-502-4104
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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 | 23D2063832
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License Number State | MI
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