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General NPI Number Information
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NPI Number | 1598173874
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Entity Type | Organization
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Legal Business Name | TRIWEST LABORATORIES
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 24555 SOUTHFIELD RD SUITE 110
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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 | 214-716-0589
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Fax |
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Provider Business Mailing Address
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Address Line | 1565 W MAIN ST STE 208 PMB 215
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City | LEWISVILLE
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State | TX
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Zip | 75067-3397
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | MR. UMAIR AHMAD
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Credential | MD
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Telephone | 214-226-2973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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