MEDICARE: GRATE DRAWMOBLIE LAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1164352167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRATE DRAWMOBLIE LAB LLC

Provider Business Mailing Address
First Line	:	2951 S ETHEL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48217-1531
Country	:	US
Telephone Number	:	313-465-3569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2951 S ETHEL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48217-1531
Country	:	US
Telephone Number	:	313-465-3569
Fax Number	:

Authorized Official
Title or Position	:	PHLEBOTOMIST
Name	:	MS. JAZMIN XAVIER PARKS
Credential	:
Telephone Number	:	313-465-3569

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “GRATE DRAWMOBLIE LAB LLC ” Practice Location

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