Provider Demographics
NPI:1083635163
Name:FRANCES WARDE MEDICAL LABORATORY
Entity Type:Organization
Organization Name:FRANCES WARDE MEDICAL LABORATORY
Other - Org Name:WARDE MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SITWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-214-0300
Mailing Address - Street 1:300 W TEXTILE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9548
Mailing Address - Country:US
Mailing Address - Phone:734-214-0300
Mailing Address - Fax:734-214-0399
Practice Address - Street 1:300 W TEXTILE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9548
Practice Address - Country:US
Practice Address - Phone:734-214-0300
Practice Address - Fax:734-214-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0650611291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI690H115080OtherBLUE CROSS
MI2625638Medicaid
MI2625638Medicaid