MEDICARE: ALPHA MEDICAL LABORATORY 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1861269151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL LABORATORY LLC

Provider Business Mailing Address
First Line	:	31420 NORTHWESTERN HWY
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2508
Country	:	US
Telephone Number	:	248-579-1400
Fax Number	:	855-538-1400

Provider Business Practice Location Address
First Line	:	31420 NORTHWESTERN HWY
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2508
Country	:	US
Telephone Number	:	248-579-1400
Fax Number	:	855-538-1400

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	REMA HAZIME
Credential	:
Telephone Number	:	248-579-1400

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	01/30/2025

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