Provider Demographics
NPI:1053314146
Name:BIOTECH CLINICAL LABORATORIES INC
Entity Type:Organization
Organization Name:BIOTECH CLINICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-912-1700
Mailing Address - Street 1:25775 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1849
Mailing Address - Country:US
Mailing Address - Phone:248-912-1700
Mailing Address - Fax:248-912-1730
Practice Address - Street 1:25775 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1849
Practice Address - Country:US
Practice Address - Phone:248-912-1700
Practice Address - Fax:248-912-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0709666291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2928322Medicaid
MI0F31535OtherBCBS
MI0Q21535Medicare PIN