Provider Demographics
NPI:1033590427
Name:INTERSTATE PHLEBOTOMY SERVICES INC
Entity Type:Organization
Organization Name:INTERSTATE PHLEBOTOMY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-746-6332
Mailing Address - Street 1:3200 DROVER LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-1642
Mailing Address - Country:US
Mailing Address - Phone:219-746-6332
Mailing Address - Fax:219-980-2995
Practice Address - Street 1:3200 DROVER LN
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-1642
Practice Address - Country:US
Practice Address - Phone:219-746-6332
Practice Address - Fax:219-980-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service