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General NPI Number Information
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NPI Number | 1790274678
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Entity Type | Organization
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Legal Business Name | HERITAGE LABS, INC.
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Dates
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Enumeration Date | 05/06/2018
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 30600 TELEGRAPH RD STE 1375
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4589
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Country | US
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Telephone | 248-720-4080
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Fax | 248-712-6100
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Provider Business Mailing Address
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Address Line | 30600 TELEGRAPH RD STE 1375
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4589
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Country | US
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Telephone | 248-720-4080
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Fax | 248-712-6100
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Authorized Official
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Title or Position | COO
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Name | NAMEER KIMINAIA
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Credential |
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Telephone | 248-720-4080
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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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