MEDICARE: VIDA CLINICAL STUDIES

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1184384224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA CLINICAL STUDIES

Provider Business Mailing Address
First Line	:	24326 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2234
Country	:	US
Telephone Number	:	480-262-7993
Fax Number	:

Provider Business Practice Location Address
First Line	:	24326 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2234
Country	:	US
Telephone Number	:	480-262-7993
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HISHAM ATRISS
Credential	:
Telephone Number	:	480-262-7993

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	08/17/2022

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Directions to “VIDA CLINICAL STUDIES ” Practice Location

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