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General NPI Number Information
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NPI Number | 1710237870
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Entity Type | Organization
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Legal Business Name | APOLLO DIAGNOSTICS LABORATORY INC
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 21999 FARMINGTON RD SUITE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-4400
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Country | US
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Telephone | 248-615-3100
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Fax | 248-615-0136
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Provider Business Mailing Address
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Address Line | 21999 FARMINGTON RD SUITE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-4400
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Country | US
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Telephone | 248-615-3100
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Fax | 248-615-0136
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Authorized Official
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Title or Position | OWNER
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Name | BASSAM MANSOOR
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Credential |
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Telephone | 248-615-3100
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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 |
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