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General NPI Number Information
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NPI Number | 1972957264
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Entity Type | Organization
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Legal Business Name | METRO CLINICAL LABORATORY, LLC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 312 W LAKE ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4898
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Country | US
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Telephone | 612-222-7990
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Fax | 612-886-9481
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Provider Business Mailing Address
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Address Line | P.O BOX 80502
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City | MINNEAPOLIS
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State | MN
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Zip | 55408
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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 | PRESIDENT
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Name | ABDINASIR AHMED
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Credential |
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Telephone | 61222279904
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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 | 851814900038
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License Number State | MN
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