Provider Demographics
NPI:1083832836
Name:DETROIT BIO MEDICAL LABORATORIES,INC
Entity Type:Organization
Organization Name:DETROIT BIO MEDICAL LABORATORIES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZAKARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:248-471-4111
Mailing Address - Street 1:23955 FREEWAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2817
Mailing Address - Country:US
Mailing Address - Phone:247-471-4111
Mailing Address - Fax:248-471-2340
Practice Address - Street 1:601 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:EAST JORDAN
Practice Address - State:MI
Practice Address - Zip Code:49727-9383
Practice Address - Country:US
Practice Address - Phone:234-536-7599
Practice Address - Fax:248-471-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002174291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3118292Medicaid
MI=========OtherTAX ID
MI0M04720Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER