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General NPI Number Information
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NPI Number | 1669840674
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Entity Type | Organization
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Legal Business Name | IMMUCOR GTI DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 301 MICHIGAN ST NE SUITE 580
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3314
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Country | US
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Telephone | 616-284-3818
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Fax | 616-284-3838
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Provider Business Mailing Address
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Address Line | 301 MICHIGAN ST NE STE 574
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3314
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Country | US
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Telephone | 616-284-3818
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Fax | 616-284-3738
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Authorized Official
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Title or Position | VICE PRESIDENT, CHIEF ADMINISTRATIV
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Name | MS. MARGARET TAYLOR
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Credential |
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Telephone | 770-225-8501
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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 | 23D1054909
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License Number State | MI
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