Provider Demographics
NPI:1003245937
Name:MORIDANI, MAJID
Entity Type:Individual
Prefix:
First Name:MAJID
Middle Name:
Last Name:MORIDANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 LEBANON RD APT 4202
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6112
Mailing Address - Country:US
Mailing Address - Phone:414-949-1355
Mailing Address - Fax:
Practice Address - Street 1:2564 N 124TH ST # 412
Practice Address - Street 2:PRUDENT DIAGNOSTICS LABORATORIES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1050
Practice Address - Country:US
Practice Address - Phone:414-949-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist
No291U00000XLaboratoriesClinical Medical Laboratory