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General NPI Number Information
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NPI Number | 1700064953
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Entity Type | Organization
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Legal Business Name | CANDU LAB SERVICES
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 2118 INWOOD DR SUITE 121
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City | FORT WAYNE
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State | IN
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Zip | 46815-7115
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Country | US
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Telephone | 260-804-6727
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Fax | 260-918-0218
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Provider Business Mailing Address
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Address Line | 2118 INWOOD DR SUITE 121
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City | FORT WAYNE
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State | IN
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Zip | 46815-7115
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Country | US
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Telephone | 260-804-6727
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Fax | 260-918-0218
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICOLAE CANDU
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Credential |
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Telephone | 260-804-6727
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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 | IN
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