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General NPI Number Information
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NPI Number | 1992088918
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Entity Type | Organization
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Legal Business Name | GREAT LAKES MEDICAL LABORATORIES, INC.
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 13530 MICHIGAN AVE SUITE 248
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City | DEARBORN
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State | MI
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Zip | 48126-3574
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Country | US
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Telephone | 248-770-8707
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Fax |
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Provider Business Mailing Address
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Address Line | 13530 MICHIGAN AVE SUITE 248
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City | DEARBORN
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State | MI
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Zip | 48126-3574
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Country | US
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Telephone | 248-770-8707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HUSAIN ALI SALEH
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Credential | M.D.
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Telephone | 248-770-8707
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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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