Provider Demographics
NPI:1164677423
Name:PHOENIX CLINICAL LABS INC
Entity Type:Organization
Organization Name:PHOENIX CLINICAL LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELSHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-748-9743
Mailing Address - Street 1:12115 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 324
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8755 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3047
Practice Address - Country:US
Practice Address - Phone:317-748-9743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-28
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046076A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty